Renal and cardiovascular repercussions in preeclampsia and their impact on fluid management: a literature review

A rare case with double trouble: Peripartum cardiomyopathy and preeclampsia together with placental abruption resulting in both cardiac and kidney failure

Peripartum cardiomyopathy and hypertensive disorders of pregnancy are not very uncommon in routine practice, but when associated with abruptio placentae and significant hypotension, survival of both child and mother becomes challenging. We report a case of a 20-year-old primigravida who presented in the gynecology emergency unit of our hospital with an ejection fraction of < 20%, severe preeclampsia with abruptio placentae leading to fetal demise, and renal failure in the immediate postoperative period. Challenges faced during decision making regarding the mode of delivery and grave concerns during intraoperative and postoperative periods are discussed. In this case, prompt termination of pregnancy, various point-of-care sonographic measurements, and post-operative emergency dialysis played vital roles in the complete recovery of this patient with a failing heart and grossly jeopardized hemodynamics. Hence, multidisciplinary team-based management is crucial for managing such cases to prevent maternal mortality and morbidity.

Acute Heart Failure in a Pregnant Woman with Preeclampsia: a Rare Case of Takotsubo Syndrome

The mechanisms of takotsubo syndrome, better known as stress-induced cardiomyopathy, are not fully understood. The article presents a clinical case of the development of acute left ventricular failure in a 39-year-old pregnancy against the background of severe preeclampsia. Echocardiography revealed a decrease in global myocardial contractility, hypo-akinesia of the apex and all median parts of the left ventricle, hyperkinesis of the basal parts. After 2 weeks, myocardial contractility was normal, no contractility impairment was found. Two months after the acute episode of the disease, magnetic resonance imaging of the heart was performed, according to which no pathological changes were detected. Based on the clinical picture, electrocardiogram changes, laboratory data and typical transient echocardiographic changes, it was suggested that the patient had takotsubo syndrome.