23033875 Visualization

The 31 Age - year Age - old Age white Personal_background primipara History with History twin History pregnancy History was admitted Clinical_event to hospital in the 38th Date week Date of Date gestation Date with elevated Sign_symptom blood Sign_symptom pressure Sign_symptom ( 150/100 Lab_value mmHg Lab_value ).
After receiving antihypertensive Medication treatment Medication blood Diagnostic_procedure pressure Diagnostic_procedure was 120/80 Lab_value .
All laboratory Diagnostic_procedure variables, Diagnostic_procedure including Diagnostic_procedure plasma Diagnostic_procedure proteins Diagnostic_procedure , were within Lab_value their Lab_value respective Lab_value reference Lab_value intervals Lab_value .
Few Time hours Time after Time admission Time to Time the Time hospital Time the contractions Sign_symptom started Sign_symptom , and the caesarean Therapeutic_procedure section Therapeutic_procedure was performed because of vertex Sign_symptom - transverse Sign_symptom presentation Sign_symptom of Sign_symptom twins Sign_symptom .
Liveborn Subject female Subject and Subject male Subject were delivered Therapeutic_procedure .
The postoperative Detailed_description course Detailed_description was initially inconspicuous Sign_symptom .
Four Time hours Time postpartum Time she experienced sudden Detailed_description epigastric Sign_symptom pain Sign_symptom .
The blood Diagnostic_procedure pressure Diagnostic_procedure rose to 190/130 Lab_value .
Laboratory Diagnostic_procedure findings Diagnostic_procedure showed haemolysis Sign_symptom , thrombocytopenia Sign_symptom , and an increase Lab_value in serum Diagnostic_procedure creatinine Diagnostic_procedure and aminotransferases Diagnostic_procedure (Table I).
Intravenous Administration magnesium Medication sulphate Medication was administered.
Abdominal Diagnostic_procedure ultrasound Diagnostic_procedure disclosed an empty Detailed_description uterine Biological_structure cavity Biological_structure without placenta Sign_symptom residue Sign_symptom .
Five Time hours Time postpartum Time , the patient was transferred Clinical_event to the intensive Nonbiological_location care Nonbiological_location unit Nonbiological_location because of poor Sign_symptom urine Sign_symptom output Sign_symptom , drowsiness Sign_symptom , and suspicion Detailed_description of DIC Disease_disorder .
On examination Diagnostic_procedure she was sleepy Sign_symptom and disoriented Sign_symptom .
The combination of haemolysis Coreference , thrombocytopenia Coreference , and elevated Coreference liver Coreference enzymes Coreference suggested a postpartum Disease_disorder HELLP Disease_disorder syndrome Disease_disorder , complicated by DIC Coreference .
The patient was rehydrated Therapeutic_procedure , and treatment Therapeutic_procedure was instituted with fresh Detailed_description frozen Detailed_description plasma Therapeutic_procedure , red Biological_structure cell Biological_structure transfusion Therapeutic_procedure , fresh Detailed_description platelets Therapeutic_procedure , and kybernin Therapeutic_procedure P Therapeutic_procedure ( antithrombin Coreference III Coreference ).
High Lab_value serum Diagnostic_procedure urea Diagnostic_procedure , creatinine Diagnostic_procedure , and persistent Detailed_description anuria Sign_symptom were compatible with acute Detailed_description renal Disease_disorder failure Disease_disorder .
A high Dosage dose Dosage of furosemide Medication failed to increase Therapeutic_procedure diuresis Therapeutic_procedure .
Sixteen Time hours Time postpartum Time her blood Diagnostic_procedure pressure Diagnostic_procedure was 60/40 Lab_value and oxygen Diagnostic_procedure saturation Diagnostic_procedure 70% Lab_value .
Few Time minutes Time later Time the patient had acute Detailed_description cardiac Disease_disorder arrest Disease_disorder , and resuscitation Therapeutic_procedure started.
Resuscitation Coreference was successful Detailed_description , and normal Sign_symptom heart Sign_symptom action Sign_symptom was re-established; blood Diagnostic_procedure pressure Diagnostic_procedure rose to 150/110 Lab_value , and oxygen Diagnostic_procedure saturation Diagnostic_procedure was 90% Lab_value .
Laboratory Diagnostic_procedure findings Diagnostic_procedure were deteriorated Lab_value , and development of acute Detailed_description renal Coreference failure Coreference indicated the necessity of urgent Detailed_description dialysis Therapeutic_procedure .
Following Time dialysis Time , the patient was stable Sign_symptom , oxygen Diagnostic_procedure saturation Diagnostic_procedure 98% Lab_value .
Twenty Time hours Time postpartum Time patient developed again cardiopulmonary Disease_disorder arrest Disease_disorder .
Despite resuscitation Therapeutic_procedure attempts Therapeutic_procedure the outcome was lethal Outcome .
Due to the fact that death Coreference occurred in the hospital Nonbiological_location a short Time time Time after Time a Time surgical Time intervention Time , a medico Diagnostic_procedure - legal Diagnostic_procedure autopsy Diagnostic_procedure was ordered Clinical_event .
An autopsy Coreference revealed oedema Sign_symptom of the brain Biological_structure and lungs Biological_structure as well as dilatation Sign_symptom of right and Biological_structure left Biological_structure ventricles Biological_structure .
Hydrothorax Sign_symptom ( 900 Lab_value mL Lab_value ), hydroperitoneum Sign_symptom ( 2500 Lab_value mL Lab_value ), and hydropericardium Sign_symptom ( 200 Lab_value mL Lab_value ) were present.
The field of operation of the caesarean Therapeutic_procedure section Therapeutic_procedure was unremarkable Sign_symptom .
Petechial Sign_symptom and Sign_symptom suffusional Sign_symptom haemorrhages Sign_symptom were observed under the pleura Biological_structure , endocardium Biological_structure , in the mucosae Biological_structure of the renal Biological_structure pelvis Biological_structure , and peritoneum Biological_structure of the small Biological_structure and Biological_structure large Biological_structure bowel Biological_structure .
Histology Diagnostic_procedure revealed periportal Detailed_description hepatocellular Biological_structure necrosis Sign_symptom , bloodless Detailed_description glomeruli Biological_structure with Sign_symptom swollen Detailed_description and Sign_symptom vacuolated Detailed_description intracapillary Biological_structure cells Biological_structure , as well as confluent Detailed_description haemorrhages Sign_symptom in kidneys Biological_structure , liver Biological_structure , and spleen Biological_structure .
Death Outcome was attributed to multiple Detailed_description organ Disease_disorder failure Disease_disorder due to DIC Disease_disorder as a consequence of HELLP Disease_disorder syndrome Disease_disorder .