Story of an Eclampsia

SB, came at around 1:30 in the afternoon today with a history of seizures since early morning. She was taken to the nearby district hospital at Garhwa, from where they asked her to be taken to a higher centre.

SB was unconscious and to make things busy for us – the baby was alive. We took the chance to post her for a Cesarian section – when we discovered to our horror that this was her second child and her first delivery had happened by Cesarian section too. This one looked quite big a baby and even if he was dead we could end up with a Cesarian.

SB’s bystanders were quite ready for any eventuality. They had been warned by the district hospital nurse that SB was quite sick. They readily agreed for the surgery and went ahead to arrange for blood.

We took SB in for the surgery. The baby was quite large and was caked in meconium. There was only a heartbeat with no respiratory effort. Dr. Johnson was around to help out to resuscitate the baby. We promptly intubated the child and were sucking out lots and lots of meconium out of the mouth and the larynx. To complicate matters, SB had received about 20 mg of Diazepam elsewhere before she reached there. So, the child was also having the effect of the Diazepam on him.

After almost an hours of mechanical ventilation, SB showed signs of recovering. He started to cry – but his saturation was going down when we wanted to take off the mechanical ventilation. This was when I realized that we would have benefitted from a neonatal ventilator for such babies.

We kept on bagging for about one more hour although SB was fighting with us to take off the endotracheal tube but as the oxygen saturation was not being maintained, we kept bagging. Ultimately, we had to give in and thankfully realised that oxygen saturation was being maintained on just oxygen mask.

Dr Johnson giving a stomach wash couple of hours after the delivery

It was then that I noticed small vesicles all over SB’s son. It looked like pox. The nurse told me that it was there when he had come out. I could not think of anything else other than the possibility of the skin having been burnt by the presence of meconium for quite a long time. The colour of the cord was another indication for the same.

Vesicular lesions on the baby

The meconium stained umblical cord

SB is on the way to recovery. Today morning, she remains groggy but better than how she had come. The baby was doing so well and was very hungry that I’ve started him on oral feeding. He is doing well.

Sr. Bharati, our nursing superintendent with the baby after things settled

Now, there is another part of SB’s story which I wanted to highlight – which is quite a serious matter. I later found out that SB had not become sick overnight. SB had developed headache and severe swelling of both her feet 2 weeks back. Her family had taken her to a doctor.

I would have wanted to place a copy of the doctor’s slip in this post, later decided against it. There is no mention about blood pressure being taken. There is no mention about urine albumin being done. The blood pressure or the serum albumin may have been normal when she had made the visit. But, when she reached NJH yesterday, SB’s blood pressure was 180/130 and urine albumin 4+.

It is a bit sad that this is missing in her Outpatient Chart of a visit made 2 weeks back. I could have also made such a miss especially in a very busy OP. But incidents such as these make us more aware of looking out for danger signs in the pregnant patients who come for regular antenatal care to us.