Massive ascites in severe pre‐eclampsia: A rare complication

Vaijyanath, Anita Matai; Nayar, Bonilla; Malhotra, Neena; Deka, Deepika

doi:10.1046/j.1341-8076.2002.00031.x

Cited by 20 publications

(20 citation statements)

References 7 publications

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“…Ascitic fluid accumulation occurs in both pregnancies complicated by PET and normal pregnancies, however, gross ascites is a rare complication of PET 13. There is a sixfold incidence of congestive heart failure and ninefold incidence of adult respiratory distress syndrome in women with hypertension, elevated Liver enzymes, low platelets (HELLP) syndrome and large-volume ascites compared to those without ascites, 14.…”

Section: Discussionmentioning

confidence: 99%

Severe hyponatraemia associated with pre-eclampsia

Anglim

Levins

Bussmann³

et al. 2016

BMJ Case Reports

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Pre-eclampsia as a rare cause of severe hyponatraemia Isotonic sodium chloride was carefully administered. She was delivered by caesarean section at 36+1 weeks because of persistent hyponatraemia and worsening symptoms of pre-eclampsia as well as suspected acute fatty liver (ALT 1348 iu/L; NR <40 iu/L). A male infant was born (Apgar score 9 at 10 minutes)-he had mild hyponatraemia-corrected by the paediatricians. Within 24 hours of delivery, maternal hyponatraemia had improved to 133 mmol/L. This is illustrated in Figure 1. Recovery was complicated by intrapartum sepsis. She was discharged eight days later with a normal BP. Discussion Pregnancy involves physiological changes affecting water/ sodium homeostasis. However, most women with PET do not develop hyponatraemia. A recent review of 332 pregnancies complicated by PET found hyponatraemia to occur more frequently in older age and twin gestations; 2 both features were absent in our patient. However, she had features of severe pre-eclampsia, including uncontrolled hypertension and impaired hepatic function. We postulate that this was a case of hyponatraemia with hypervolaemia (excess extracellular sodium and total body water) as a result of impaired free water clearance secondary to pre-eclampsia. SIADH was discounted because of low urinary sodium and oedema. We draw attention to severe hyponatraemia as a biomarker of severe pre-eclampsia and as a rare indication for urgent delivery. This requires multidisciplinary management and continuing postpartum care to ensure favourable maternal/ neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Severe hyponatraemia associated with pre-eclampsia

Anglim

Levins

Bussmann³

et al. 2016

BMJ Case Reports

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“…In 1949, Golden stated that the cause of ascites in pregnancy was a low concentration of proteins with an altered albumin/globulin ratio < 1.5 [7]. Although there is no clear definition of massive ascites, arbitrarily it is defined as the presence of an amount equal to or more than 2 L of peritoneal fluid.…”

Section: Discussionmentioning

confidence: 99%

A Remedy for the Pars Pro Toto Fallacy in Chinese Semiotics

2016

Chinese Semiotic Studies

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Preeclampsia is a systemic endothelial disorder triggered by many factors originated by the human placenta. The presence of massive ascites (more than 2 L of serous liquid in peritoneal cavity) signifies rare and severe complication of preeclampsia. We present a case of 25-yearold primigravida admitted to hospital due to preeclampsia who immediately after delivery developed a clinical condition similar to hemorrhagic shock, but the explorative laparotomy revealed only massive ascites of 4.5 L serous liquid. We suggest that appearance of massive ascites in women with preeclampsia is the underestimated fact that surprises us frequently. Sometimes, its sudden onset can mimic life-threatening conditions, as happened with our patient. Cautious evaluation of peritoneal fluid quantity in women with preeclampsia could warn the obstetrician about the potential risks that demand more intensive and more frequent maternal and fetal surveillance.

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“…The present patient had pre-existing HT, obesity and DM, and the sudden fluctuations in plasma volume caused by additional severe diarrhea and vomiting due to YE enterocolitis may have further exacerbated uteroplacental hemodynamics. The incidences of large-volume ascites (≥2 L) in patients with severe PIH or HELLP (hemolysis, levated liver enzymes and lower platelet) syndrome have been reported as 2.2% and 10% [9], respectively. The exact pathophysiological mechanisms underlying ascites in PIH remain unclear, but renal retention of sodium and water and retention of water in the extravascular space are involved.…”

Section: Discussionmentioning

confidence: 99%

“…In PIH, there is extensive vascular endothelial malfunction throughout the body, encouraging water leakage from the capillaries and unpredictable protein leakage causing decreased intravascular colloid oncotic pressure and exacerbated ascites [10]. Association of hypoprotenemia as well as hypoalbuminemia with massive ascites in severe preeclampsia was reported [9,11]. Malnutrition (hypoalbuminemia) due to YE enterocolitis could potentially have played a pathogenic role and exacerbated the ascites (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Serious Influence of Yersinia Enterocolitis on Pregnancy in a Woman Complicated With Chronic Hypertension and Gestational Diabetes Mellitus: A Case Report

Asarkua¹,

Fukami²,

Inagaki³

et al. 2015

J Preg Child Health

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A 40-year-old pregnant woman admitted into hospital to treat hypertension (HT) and gestational diabetes at 19 weeks of gestation. She contracted enterocolitis due to the foodborne pathogen Yersinia enterocolitica (YE) at 22 weeks of gestation. Hypoalbuminemia and ascites developed due to prolonged intractable diarrhea and vomiting. Since 25 weeks of gestation, marked albuminuria appeared and blood pressure gradually elevated. Fetal growth was found to be retarded. Cesarean section for non-reassuring fetal status was performed at 27 weeks 2 days, delivering a 641 gr boy (-2.9 SD from averaged neonatal body weights compatible with the gestational weeks, Apgar score 3/8 at1/5min.). Gastrointestinal symptoms and ascites resolved within 1 week of delivery. This represents the first report of YE infection seriously affecting perinatal prognosis. Journal of Pregnancy and Child Health

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Massive ascites in severe pre‐eclampsia: A rare complication

Cited by 20 publications

References 7 publications

Severe hyponatraemia associated with pre-eclampsia

Severe hyponatraemia associated with pre-eclampsia

A Remedy for the Pars Pro Toto Fallacy in Chinese Semiotics

Serious Influence of Yersinia Enterocolitis on Pregnancy in a Woman Complicated With Chronic Hypertension and Gestational Diabetes Mellitus: A Case Report

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