Over the last 10 days we had 2 very sick eclampsia patients.
The common aspects of both patients . . .
- They were very rich.
- The relatives wanted to take the patient to a higher centre in Ranchi but could not as both of them had severe respiratory distress.
- Both of them had GCS of 3 on arrival.
- They had spent time at home for more than 5 hours after the first episode of seizures.
- The decision to take to a doctor was made after 5 hours.
- Both patients did not get magnesium sulphate from any healthcare providers. In fact, I got the snap of what one patient got . . . You can see it below.
- Both had pulmonary edema with pink frothy sputum coming out. In fact, the second one had coffee ground gastric contents.
- Both had diastolic blood pressures of more than 140 mm Hg on arrival.
- Both of them have survived the surgery.
- They needed mechanical ventilation for less than 24 hours.
The differences . . .
- Both were from different castes and religious communities.
- For the first case, the baby was dead. The second case has got a alive baby.
- One of them is discharged, whereas the other one is yet to go home.
- The first one, who is already discharged had to be intubated on arrival whereas the second one was intubated only for general anesthesia.
The significance of both these patients: The classical teaching of eclampsia with pulmonary edema is to stabilise them before we take up for surgery. Our experience shows that if we take them for surgery as soon as possible, they survive. However, you need to have basic ventilation.
And of course, we pray quite hard here.
Any takers for this from the speciality of Obstetrics. We have four patients who survived over the last 3 years with this sort of management. The above are the last 2 patients. The first two patients, you can read here . . .
I’m sure that we don’t see this sort of patients in clinical set ups in most of the other obstetric set ups. However, I understand that we have such patients turning up in most of the other EHA units.