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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) Solo Journal of Anesthesi, Pain and Critical Care
Sugiharto, Wahyu
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Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Nursing Public Health

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A Diagnostic Challenge in the Differential Diagnosis of Recurrent Seizures During Pregnancy: Epilepsy Versus Eclampsia Andri Subiantoro; Sugiharto, Wahyu; Khaidar, Reyfal
Indonesian Journal of Anesthesiology and Reanimation Vol. 7 No. 1 (2025): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V7I12025.35-44

Abstract

Introduction: Seizures during pregnancy are associated with adverse outcomes for mothers and infants. Seizures during pregnancy can be associated with multiple factors. To establish effective treatment and management of seizures, it is important to identify all of the factors that may contribute to seizures during pregnancy. Objective: This study aimed to evaluate and identify the cause of seizures in pregnancy to facilitate appropriate treatment. Case Report: We present a case of a 32-week pregnant woman who experienced eclampsia and recurrent seizures during the peripartum period. The patient had a history of inadequately managed epilepsy. Seizure management required multiple medications, including magnesium sulfate, benzodiazepine, and phenytoin. The patient underwent an emergency caesarean utilizing the Rapid Sequence Intubation (RSI) procedure and general anesthesia to rescue the baby. Nicardipine, furosemide, isosorbide dinitrate, captopril, spironolactone, and hydrochlorothiazide were used to manage blood pressure. The patient needs to be continuously observed, and the therapy should be adjusted according to the patient’s condition. Discussion: The patient had a history of epilepsy and had experienced two bouts of generalized seizures with characteristics of eclampsia before being arrived at the emergency room. Determining how to control the seizures in this spesific individual was a challenge. The primary therapy of patients with active seizures should include maintaining the airway, respiration, and circulation. The therapeutic objectives are immediate delivery of a viable fetus and maintenance of maternal health. Perioperative management aims to control blood pressure and seizures, maintain hemodynamics, manage anesthesia for terminating a pregnancy, and support critical care management for any potentially fatal complications from this condition. Conclusion: Seizures in pregnancy are attributable not just to eclampsia but can also cause by another or concurrently together with other causes. Early diagnosis and appropriate treatment are required to achieve the best outcome for this patient.
Anesthetic Management for Urgent Caesarean Section in Patient with Uncontrolled Hyperthyroidism and Severe Mitral Regurgitation Khaidar, Reyfal; Subiantoro, Andri; Sugiharto, Wahyu; Prasiska, Tomy Oky
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.64451

Abstract

Background :The prevalence of hyperthyroidism in pregnancy approximately 0.05% to 3% and mostly caused by Graves’ Disease (GD). The prevalence of Hyperthyroid Heart Disease (HHD) in pregnancy is 3.87%. Uncontrolled hyperthyroidism during pregnancy can increase maternal and fetal mortality. We report a case of a pregnant woman with uncontrolled hyperthyroidism and severe mitral regurgitation that underwent cesarean section with spinal anesthesia for delivery.Case Illustration :A 33 years-old patient G4P1A2 visited the Obstetric-Gynecology outpatient clinic at our hospital at 23 weeks of gestation (WoG) due to uncontrolled hyperthyroidism caused by GD that diagnosed 3 years ago and shortness of breath. The echocardiography test obtained severe mitral regurgitation and left atrial dilatation with 58% LVEF. It was decided to maintain the pregnancy till the fetus is viable while still monitoring the patient’s condition. At 32 WoG, the patient came to the ED due to shortness of breath, chest pain, and nausea. Fetal movement and fetal heart rate (FHR) were within normal limits. The patient was given a nasal cannula at 3 liters/minute, extra furosemide 20 mg, and fetal lung maturation with dexamethasone injection. The patient was prepared for termination by cesarean section. Spinal anesthesia was performed in a sitting position using a 27 G spinal needle. Inserted at L 3-4, using a low dose of heavy bupivacaine 0.5% 7.5 mg combined with 25 g fentanyl and 0.1 mg morphine intrathecally. C-section was successfully performed and hemodynamics during surgery was stable, resulting the delivery of a preterm baby who weighed 1.9 kg at birth and the baby was transferred to the NICU for further treatment.Conclusion : Spinal anesthesia with low dose bupivacaine combined with opioids for cesarean section was revealed maternal and neonate safe.
Co-Authors Andri Subiantoro Khaidar, Reyfal Prasiska, Tomy Oky Subiantoro, Andri