Morbidly Obese Preeclamptic Patient with Difficult IV Access for Urgent Cesarean Delivery
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A 34-year-old morbidly obese woman, G1P0, at 28 + 1/7 weeks estimated gestational age, is admitted from Clinic to Labor & Delivery late one afternoon for superimposed preeclampsia with uncontrolled hypertension (L-1). She has gained weight dramatically in the last few days and her face and entire body are swollen (L-2). Her admission blood pressures (BPs) are in the range of 180–190/100–110 and in Clinic she had a headache which was relieved by oral acetaminophen. Prior to pregnancy her BPs were in the 140/80 range and her first BP obtained during pregnancy was 154/82. She weighs 143 kg (315 lbs.), is 160 cm tall (5 feet 3 inches), and has a BMI of 55.8. She has gestational diabetes with a most recent HgA1c of 6.3 and is currently taking glyburide. Her other admission vital signs, including an SpO2 on room air of 98%, are unremarkable. Her lungs are clear, with no rales or wheezing (L-3), and her airway exam, while obese, appears to be consistent with routine intubation. All of the patient’s extremities reveal pitting edema and her mother states that her face is swollen (L-4).
- 2.Preeclampsia severe features, definition by the American College of Obstetrics and Gynecology, Accessed at: https://www.acog.org/~/media/Task%20Force%20and%20Work%20Group%20Reports/public/HypertensioninPregnancy.pdf 2013.
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- 5.The University of Toronto, Perioperative Interactive Education, has an outstanding website for learning ultrasound-assisted neuraxial block placement, at: http://pie.med.utoronto.ca/VSpine/VSpine_content/VSpine_lumbarAnatomy.html.
- 6.Figure 13.25 image reproduced with permission from Gordon Tait, PhD, Manager Perioperative Interactive Education, University of Toronto. I have re-labeled the image. Detailed permission information is available at: http://pie.med.utoronto.ca/obanesthesia/.