An unusual presentation of severe preeclampsia presenting with maternal collapse in the post-cesarean section secondary to drug toxicity associated with pituitary hemorrhage: a case report

Abstract

BackgroundSevere preeclampsia presenting with maternal collapse post-cesarean section secondary to drug toxicity associated with pituitary hemorrhage is rare.Case presentationA 24-year-old primigravida 27 weeks of gestation presented with severe preeclampsia, and underwent emergency cesarean section; postoperatively, she had a sudden maternal collapse and cardiac arrest while on labetalol and magnesium infusion. Following the return of spontaneous circulation (ROSC), the patient was found to have severe bradycardia with prolonged QTc interval and recurrent hypoglycemic episodes. Investigations had revealed low serum cortisol with the brain showing pituitary hemorrhage with features of atypical Sheehan’s syndrome without lactation failure.ConclusionsDrug toxicity is an important cause of maternal collapse and cardiac arrest. Pituitary hemorrhage needs to be suspected in maternal patients with recurrent hypoglycemic episodes with or without postpartum hemorrhage (PPH). Continuous monitoring, use of maternal early warning scoring systems (MEWS), and prudence in the perioperative period/labor room will help in reducing the complications.