The first case of Cesarean section in a pregnant woman during extracorporeal membrane oxygenation (ECMO) in Russia

A.A. Skopets1,2, A.S. Zharov1, S.I. Potapov1, E.S. Afonin1, M.D. Andreeva2, T.V. Galdina1, L.V. Shulzhenko1,2, E.V. Bezukh1, V.A. Porhanov1,2

1 State Public Health Budget Institution Scientific Research Institute — Ochapovsky Regional Clinic Hospital of Krasnodar Region Public Health Ministry, Krasnodar, Russia

2 State Budgetary educational institution of higher professional education Kuban State Medical University of the Ministry of Healthcare of the Russian Federation, Krasnodar, Russia

For correspondence: Alexander A. Skopets — M. D., Head of Department of Anesthesia and intensive care #2 Scientific Research Institute — Ochapovsky Regional Clinic Hospital, associate professor of the Department of Anesthesiology, Reanimatology and Transfusiology of the Kuban State Medical University, Krasnodar; e-mail: alskop1961@mail.ru

For citation: Skopets AA, Zharov AS, Potapov SI, Afonin ES, Andreeva MD, Galdina TV, Shulzhenko LV, Bezukh EV, Porhanov VA. The first case of Cesarean section in a pregnant woman during extracorporeal membrane oxygenation (ECMO) in Russia. Article. Annals of Critical Care. 2019;3:90–97.

DOI: 10.21320/1818-474X-2019-3-90-97


Abstract

A 22-year-old pregnant woman (34.6 weeks of pregnancy) with A(H1N1) influenza-associated acute respiratory distress syndrome was admitted to the intensive care unit. Results. The patient was connected to femoral-jugular veno-venous extracorporeal membrane oxygenation (ECMO) 2 hours after admission. On the 2nd day of ECMO support, in connection with the beginning of labor activity and a threat to the life of the mother and fetus, the decision was made on the implementation of caesarean section (CS) without the termination of ECMO. CS was performed under general anesthesia, 2 hours after discontinuation of heparin infusion. Were extracted a premature baby girl, weighing 2380 g. Intraoperative period was complicated by atonic uterine bleeding, requiring a hysterectomy. On the 16th day the patient was successfully weaned from ECMO and was discharged after 11 days. The newborn was discharged from the clinic in a satisfactory condition after 24 days with a weight of 2860 g. Conclusion. This is the first case in Russia of successful use of ECMO and emergency cesarean section (CS) during ECMO in a pregnant woman with acute respiratory distress syndrome (ARDS) due to complications of influenza A(H1N1).

Keywords: flu, pregnancy, extracorporeal membrane oxygenation, cesarean section.

Received: 14.08.2019

Accepted: 03.09.2019


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Pituitary Adenoma in Pregnant Patient with Acute Visual Loss: Clinical Case Report

A.Y. Lubnin1, P.L. Kalinin1, D.V. Fomichev1, K.N. Ahvlediani2, N.M. Eliseeva1, O.F. Tropinskaya1, L.I. Astaf’eva1

1FGAU NII «N.N. Burdenko Neurosurgery Institute» MZ RF, Moscow

2GBUZ MO «Moscow Regional Research Institute of Obstetrics and Gynecology», Moscow

For correspondence: Lubnin Andrei Yurevich — Head of Anesthesiology, Intensive Care Department FGAU NII «N.N. Burdenko Neurosurgery Institute» MZ RF; e-mail: lubnin@nsi.ru

For citation: Lubnin AY, Kalinin PL, Fomichev DV, Akhvlediani KN, Eliseev NM, Tropinskaya OF, Astaf’eva LI. Pituitary Adenoma in Pregnant Patient with Acute Visual Loss: Clinical Case Report. Intensive Care Herald. 2016;4:67–71.


We present patient with pituitary adenoma (prolactinoma) which manifested by dramatic decrease of visual function as a consequence of apoplexy during pregnancy. We decided to operate patient on hypophysis with preserved pregnancy. In conclusion we discus problem of brain tumor management in pregnant patients and anesthetic managements of such patients.

Keywords: pituitary adenoma, pregnancy, anesthetic management

Received: 05.11.2016


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Successful Completion of Pregnancy and Delivery in Patient in Coma

E.Yu. Upryamova1, A.L. Gridchik1, O.F. Serova2, M.V. Vatsik3, N.M. Smirnova3, E.M. Shifman4

1Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow

2Moscow Regional Perinatal Center, Balashikha

3Domodedovo central hospital, Domodedovo

4M.F. Vladimirskiy Moscow Regional Research Clinical Institute, Moscow

For correspondence: Upryamova Ekaterina Yur’evna — MD, Senior Researcher of the Department of Anesthesiology and Intensive Care, Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow; e-mail: kvyalkova@gmail.com

For citation: Upryamova EYu, Gridchik AL, Serova OF, Vatsik MV, Smirnova NM, Shifman EM. Successful Completion of Pregnancy and Delivery in Patient in Coma. Intensive Care Herald. 2016;4:62–66.


Severe neurological injury during pregnancy without intensive care for a woman is a potentially dangerous condition for both the mother and the fetus. High risk of secondary infection with the development of inflammatory complications, decompensation of vital functions of the mother due to the increased load on the organs and systems due to ongoing pregnancy have special requirements for the organization and carrying out of intensive care on the part of intensivist and obstetricians. In this clinical observation, we analyzed medical history, clinical and instrumental examination, especially prenatal care, intensive care and delivery of patient staying in persistent vegetative state being a result of severe traumatic brain injury.

The present clinical case is a unique event in Russian medical practice. Its uniqueness lies in the fact that the patient has spent in a coma in fact the entire pregnancy (4–5 weeks before a full-term period), that is more than 8 months. The obstetric department of Domodedovo central hospital performed cesarean section under general anesthesia when the term was around 36–37 weeks. In the 4th minute they extracted preterm alive weight 2180 g girl, 46 cm, with Apgar scores of 3–5 points. In May 2015, the specialists carried out in-depth examination of the child. According to the results of the survey, the child did not reveal any abnormalities in the development and health.

Thus, a consistent multidisciplinary approach, an individual program of intensive therapy, taking into account the type and extent of damage to the central nervous system, the parent status, gestational age and fetal condition allowed achieving significant results in the treatment and giving a chance to live for the child not yet born.

Keywords: pregnancy, delivery, traumatic brain injury, coma, persistent vegetative state, Glasgow score, Apgar score

Received: 23.09.2016


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