31/08/2023
- HELLP Syndrome with MODS with DIC in a case of Abruptio Placentae.
Sumita Santra , a 26 years old, G2 P1+0 mother , presented at OBG triage of MMCH with antepartum hemorrhage ( ? Abruptio placentae) with PIH at 35 weeks 5 days POG and got admitted under Dr.Ratan Chandra Mandal on 01/08/23 at 9:45 am. She underwent Emergency caesarean section at 12:36 pm on the same day. During caesarean section , around 500 ml retroplacental clots was found and there was diffuse oozing from different sites. Intra abdominal, sub-re**us and subcutaneous drains were given. Patient's vitals were stable after LSCS. She developed re**us sheath hematoma on next day morning with diffuse oozing of blood from stitch line. Her hemoglobin was dropped to 5.4 gm/dl. Blood and blood-products were transfused. She underwent emergency exploratory laparotomy followed by evacuation of re**us sheath hematoma under general anesthesia on 02.08.2023 . After securing hemostasis, one intra-abdominal drain (ROMO-ADK), one subre**us drain ( ROMO-VAC)and one subcutaneous drain ( CRS) were given. Then the patient was shifted to CCU. She developed Sepsis, ARDS, AKI, acute panceatitis and DIC . Her deranged blood reports were : WBC -34000, Platelet -24000, CRP-79, Urea -121, Creatinine -2.8, SGPT-3043, SGOT-4606 and D-dimer->20. Conservative management was done along with transfusion of multiple blood products. Total 9 units PRBC, 9 unit RDP, 13 unit FFP and 10 units cryoprecipitate were transfused. Along with this, inj hepamerz, inj vit-k, inj. MVI, tab Udiliv, tab chymoral forte, Inj Insulin etc were given and daily routine blood investigations were sent. Gradually her CBC and LFT , RFT reports become normal, but amylase ( 677 U/L) , lipase ( 1755 U/L ) and LDH ( 2750 U/L) tends to increase along with mild bulky pancreas seen in USG. Conservative management with tab creon and others were given and it got resolved spontaneously. Patient started recovering gradually and was shifted to HDU after 10 days and then to general ward . After 30 days of long battle she got discharged on 31.08.2023. Patient and her relatives expressed special gratitude to Dr Ratan Chandra Mandal and his team for giving her a new life and returning a mother to her newborn.