Spinal anaesthesia for emergency caesarean section in a parturient with acute subarachnoid haemorrhage

Abstract

Case report: We report a case of 36 years-old primigravida at 34 weeks of gestation with known temporal lobe epilepsy, who was brought in by ambulance with tonic clonic seizure of more than 30 minutes duration. In view of her high blood pressure and seizure we decided to treat her as eclampsia and performed emergency caesarean section, as she was seizure free for the past 11 years. The women received treatment according to our hospital guideline for eclampsia to lower her blood pressure and underwent emergency operation under general anaesthetic. She was transferred to ITU, extubated the same day with no adverse outcome and the baby admit ted to special care unit. Discussion: Well controlled epilepsy may improve or even deteriorate during pregnancy(1). Usually women with poorly controlled epilepsy can get worse during pregnancy. Dif ferentiation between seizures caused by epilepsy or due to eclampsia is important as the management dif fers for both. In such situations patients should be treated as eclampsia unless otherwise proved(2). But uncontrolled seizures caused by either are detrimental to baby and will need delivering. In our patient as she had status like seizure on presentation with high blood pressure we had to treat her as eclampsia and treat accordingly. When her blood results were available, she had normal LFT’s and platelets which is one of the diagnostic feature against eclampsia. References: 1. Calderwood C, Nelson-Piercy C, Medical disorders complicating pregnancy. Anaesthes Intensive Care Med 2004;5(8):256-263 2. Wee L, Sinha P, Lewis M. The management of eclampsia by obstetric anaesthetists in UK: a postal survey.Int J Obstet Anesth. 2001;10(2):108-112 Learning points: Dif ferentiation between seizures caused by epilepsy or due to eclampsia in an acute situation is dif ficult. It is important to dif ferntiate between these conditions, as the management dif fers for both. In such situations patients should be treated as eclampsia unless otherwise proved.