Brain Damage Associated with Cardiomyopathy of Pregnancy with Notes on Caesarian Section in a Hyperbaric Chamber.

McA. Ledingham, M.B.,Ch.B. ; T. I. McBride, M.B., M.R.C.P.; W. B. Jennett, M.D.; F.R.C.S. Brit. Med. J., 1968,4,285-287.

Case Report:

On 26 December 1966, a 22 year-old Prim Para in her 37th week was admitted to a maternity hospital for observation because of a minor antepartum hemorrhage. While in bed at 6.50 p.m. on 16th January 1967, she complained of pins and needles in her left limb and abruptly became unconscious and cyanosed with sterorous respiration. (Amniotic Embolism) Because of the marginal improvement which had taken place in the patient's condition with 100% oxygen at normal pressure, and because of the onset now of fetal distress (the fetal heart rate had risen to 200/min and was irregular), it was decided to assess the effect of oxygen administration at 2 atmospheres absolute. Before compression started the patient began to have generalized convulsions, which became continuous in minutes. Her condition deteriorated until death was thought to be imminent. Following hyperbaric oxygenation at 2 ata there was a marked improvement in the patient's condition: the blood pressure rose to 100/70 mm Hg and the periphery became warm and pink. The fetal heart rate, which had been 220 and irregular immediately before compression, fell to 165 and became regular. Caesarian section was now performed, and preceded smoothly, though it was noted that the uterus remained slightly cyanosed in spite of the high maternal arterial oxygen tension. A normal live female child was born with an Apgar score of 9.

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