Twin pregnancy with HELLP SYNDROME with DIABETES INSIPIDUS

1. Twin pregnancy with HELLP
SYNDROME with DIABETES
INSIPIDUS
Case Presentation
By - Dr.Manjushree Boob
M.B.B.S.,M.D.,D.N.B.,F.I.C.M.C.H.
FELLOWSHIP LAPAROSCOPIC SURGERY
& INFERTILITY [FRANCE]
Dr. Saima Khan [D.R.C.H. Student]
Dr.Shweta Soni [D.R.C.H. Student]

2. MRS. PT 24YRS. 3RD GRAVIDA WITH TWIN PREGNANCY
CAME AT 34 WEEKS FOR ANC CHECKUP
 O/E :
 G.C. Better
 Affebrile
 No Pallor
 Oedema ++
 Rs/cvs-Normal
 P/A-ut.OD
 Mfp +nt
 Both FHS reg.140/mins
 Presentation
 1st Vertex
 2nd Breech
 B.P 160/110mm/hg
 DTR +nt
 Adv:PIH profile
 Admission

3.  She came with mild headache nausea
 Her BP was 160/110
 Oedema+++
 Got immidiately admitted
 PIH profile done

4. INVESTIGATION
 HB-8.5gm%
 Bld group- AB+ve
 Haematocrit-30.0
 MCV-100.0
 MCH-28.3
 TWC-8,800
 S.G.O.T-70
 SERUM LDH-361
 KFT:
serum creatinine-1.10
serum sodium-142
serum potassium 3.3
serum ionised calcium-
1.1

5. MANAGEMENT
 Inj mgso4 4gm loading dose given after checking DTR
 RR was 18/min
 Output in last 4hr was more then 400ml.
 Pt already on Tab Labetelol tds.
 Tab. Nicardia 2mg BD started
 BP & FHS monitoring maintained

6.  After 6 hrs she had developed suttle convulsion
& had a fall.
 Reports of PIH profile had come and was
suggestive of HELLP.
 Immidiately shifted to OT for emergency LSCS
after explaining all risk &complication to
relatives.

7.  Pt operated under SA
 Lscs done 1st baby by vx and 2nd by breech.
 Both females weight 2.3kg and 2.1kg cried
immediately.
 No PPH,no cyanosis
 I/O uneventfull.

8. POSTOPERATIVE MANAGEMENT
 Pt.had I/O output of1500ml&then in 24hrs output were
5500ml.
 Physician was consulted.
 Strict intake and output chart was maintained
 24hrs output was 6-7liters.
 Daily KFT ,Serum eletrolytes and urine specific gravity was
seen .
 Pt managed conservativly till d-4.

9.  But as output was always more then 6liters.
 Nasal vasopressin spray was given and in 2 doses 4 hrs
apart she responded completely.
 Pt was discharged on D-8 in absolute healthy condition
and good suture line.