Healthy Parturient Research Articles

Milk Exosomes from Gestational Diabetes Mellitus (GDM) and Healthy Parturient Exhibit Differential miRNAs Profiles and Distinct Regulatory Bioactivity on Hepatocyte Proliferation.

Exosomes, a novel type of bioactive component in human milk (HM), affect infant development, growth, and health. Recent studies indicate that HM exosomes and miRNAs relate to gestational diabetes mellitus (GDM). However, the miRNAs profiles and functionalities of HM exosomes from GDM parturient remain unclear. This study aims to compare the differential miRNAs in HM exosomes from GDM and healthy parturient, and investigate the HM exosomes bioactivities in regulating hepatocyte proliferation and insulin sensitivity. This study extracted HM exosomes from GDM (GDM-EXO) and healthy (NOR-EXO) parturient by ultracentrifugation, high-throughput sequenced and compared the exosomal miRNAs profiles, and explored the regulatory bioactivities on hepatocyte proliferation in HepG2 cells and Balb/c mice. As compared to NOR-EXO, GDM-EXO has similar morphology, size, concentration, and exosome-specific markers (CD9 and TSG101) expression. GDM-EXO and NOR-EXO specifically harbor 1299 and 8 miRNAs, respectively. Moreover, GDM-EXO had 176 upregulated and 47 downregulated miRNAs compared with NOR-EXO. Both GDM-EXO and NOR-EXO were absorbed in cultured HepG2 hepatocytes and mice liver. GDM-EXO inhibited hepatocytes proliferation by downregulating mammalian target of rapamycin (mTOR) possibly via exosomal miR-101-3p delivery. HM exosomes from GDM and healthy parturient exhibit differential miRNAs profiles and distinct regulatory bioactivity on hepatocyte proliferation.

COMPARISON OF ERECTOR SPINAE PLANE BLOCK & CONVENTIONAL ANALGESIC TECHNIQUE FOR POSTOPERATIVE PAIN RELIEF IN CAESAREAN SECTION – A PROSPECTIVE RANDOMISED STUDY

Background: Postoperative pain relief after caesarean delivery is challenging because it needs to provide maternal satisfaction while having no adverse effects on the baby. The study aimed to compare the analgesic efcacy of bilateral ESP block with that of conventional technique after elective LSCS under SAB. In this single blind randomized, prospective comparative Methods: study, 76 healthy parturient were randomly divided into two groups. Group1 received bilateral ESPB using 0.2% ropivacaine (0.2ml/kg) before spinal anaesthesia, Group 2 received conventional postoperative analgesics on patient's demand. The duration of postoperative analgesia and VAS pain score was recorded for 24hrs. Onset & duration of sensory and motor block, hemodynamic parameters and adverse effects were assessed. Data analysis was done with statistical software SPSS Version. 24 with Unpaired T test and Chi-square test. The duration of anal Results: gesia (152.55 ± 64.46mins vs 96.68 ± 36.09mins) was signicantly prolonged in Group ESPB than Group Control (P<0.0001) The mean VAS score was signicantly less in ESPB group at 2hr (P value =0.0243), 12hr (P value = 0.0250) and 24hrs (P value = 0.0408) postoperatively. ESPB group of patients require less analgesic dose of inj. Tramadol (P= 0.0389), inj. Diclofenac sodium (P <0.0001) and inj. Paracetamol (P= 0.0423) as compared to that of Control group with signicant difference. Onset of sensory and motor block was signicantly faster in ESPB Group than Control Group. ESP block provides more effective Conclusion: pain relief, longer duration of analgesic action, prolongs time to rst analgesic requirement, associated with less consumption of conventional analgesics and also potentiates the onset of sensory and motor block.

Spinal Anesthesia in a Healthy Parturient Causing Suspicious Bullous Skin Lesions: A Case Report

We present a case of suspicious bullous skin lesions after spinal anesthesia in a previously healthy parturient presenting at term for an elective secondary cesarean section. On day 1 post-partum, pruritic red fluid-filled clustered bullae highly resembling those of bullous pemphigoid were noted around the spinal anesthesia injection site.

Life-Threatening Amniotic Fluid Emboli Requiring Massive Blood Transfusion and Veno-Arterial Extracorporeal Membrane Oxygenation Therapy: Case Report and Review of the Literature

Background: Amniotic fluid embolism (AFE) is a rare and disastrous condition that occurs during labor or soon after delivery. Its course is abrupt and rapidly progressive and may result in cardiorespiratory collapse, profound hemorrhage and multi organ failure. Mortality and morbidity are high, with many survivors suffering major neurologic sequelae. Disseminated intravascular coagulation (DIC), severe coagulopathy and hemorrhage may pose a risk for extracorporeal membrane oxygenation (ECMO) therapy due to the need of full anticoagulation treatment. Case Report: A 41 year old healthy parturient who developed fulminant AFE during cesarean delivery, accompanied by cardiac arrest, severe acute respiratory distress syndrome and DIC with profound obstetric hemorrhage. She was placed on veno-arterial ECMO as a rescue therapy and required more than 850 blood products. She had concomitant septic shock with E-coli bacteremia due to chroioamnionitis. Despite prolonged and complicated ICU course, including recurrent hemorrhage, multiple surgeries and sepsis, she survived to hospital discharge without neurologic sequelae. Conclusion: ECMO therapy may be considered as a rescue therapy in AFE cases, refractory to standard cardiorespiratory support, despite the increased risk for hemorrhage under full anticoagulation therapy. Interdisciplinary coordination is mandatory for a good outcome.

Comparison of hemodynamic changes and fetal outcome between normotensive and preeclamptic parturient undergoing elective cesarean section under spinal anesthesia: A prospective observational cohort study

BackgroundMaternal hypotension is a common problem during spinal anesthesia resulting in adverse maternal and fetal outcomes. According to theoretical knowledge, it is more common in severe preeclamptic parturients undergoing cesarean section with spinal anesthesia. ObjectiveTo compare fetomother outcome in normotensive and severe preeclamptic parturients undergoing elective cesarean section under spinal anesthesia. MethodologyA prospective cohort study was conducted from Novembers to May 30, 2019 on 84 ASA II and III pregnant mothers. After preloading with 500 ml–1000ml crystalloids, a 0.5%isobaric bupivacaine of 10 mg–12.5 mg was administered for spinal anesthesia.Vital signs (SBP, DBP, MAP and HR) were recorded every 3 min till 30 min, every 5 min then after. Neonatal Apgar scores at one and 5 min after birth and intraoperative fluids consumption were recorded. Data distribution was checked by Shapiro walk's test. Chi-square test was used to calculate the incidence of hypotension between groups; both paired and unpaired t-tests were also used to calculate the percent fall in blood pressure and heart rate from baselines of each group and intergroup respectively, and P-value less than 0.05 were considered statistical significance. ResultsThe incidence of hypotension (over a period of 30 min after spinal anesthesia) in the preeclamptic patients (31%) was less than that of the healthy parturients (59.5%). There was no statistically significant difference in heart rate of both groups before and after induction of spinal anesthesia. The 5th minute Apgar score recordings were also comparable between the groups. ConclusionThis study showed that the incidence and magnitude of spinal anesthesia-induced hypotension was less in severely preeclamptic parturient than healthy parturient who underwent elective cesarean delivery under spinal anesthesia and fetal outcome was comparable.

Sudden respiratory and circulatory collapse after cesarean section: Amniotic fluid embolism or other reasons? \u2013 a case report

BackgroundFor a healthy parturient, a cardiopulmonary collapse that suddenly occurs shortly after an uneventful caesarean section is a relatively rare event and presents a significant challenge for the anesthesia provider.Case presentationAmniotic fluid embolism (AFE) is characterized by acute and rapid collapse and is well known to the obstetric team. Our patient experienced sudden cardiovascular collapse, severe respiratory difficulty and hypoxia, in the absence of other explanations for these findings at the time, and thus AFE was immediately become the focus of the consideration. However, there is no quick, standard laboratory test for AFE, therefore the diagnosis is one of exclusion based on presenting symptoms and clinical course. After given symptomatic treatment, the patient made an uneventful initial recovery in a short period and developed a rash. We recognized that the postpartum shock was associated with delayed anaphylaxis of antibiotics.ConclusionsThese observations have implications for understanding whenever administering drugs in surgery, which may affect the anesthesiologist’s judgment regarding the complications of anesthesia. Even though serious complications of common perioperative drugs may rarely occur, anesthesia providers should be aware of the consideration. Early recognition and effective treatment are more important than prompt diagnosis.

Interleukin 22 Expression During the Implantation Window in the Endometrium of Women with Unexplained Recurrent Pregnancy Loss and Unexplained Infertility Compared to Healthy Parturient Individuals.

We evaluated the expression of interleukin-22 (IL-22) in the endometrium of women with unexplained recurrent pregnancy loss (uRPL) and unexplained infertility (UI) compared to the women with normal pregnancies. Endometrial tissues were collected from 20 women with UI, 20 women with uRPL, and 24 healthy women as a control group. Immunohistochemical expression and gene expression of IL-22 were analyzed by immunohistochemistry (IHC) and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) methods. The controls showed lower IL-22 expression than the uRPL group (P > 0.05) using PCR. It was also found that patients with UI had lower levels of IL-22 expression compared to the uRPL group (P > 0.05). Although IL-22 expression in the endometrium of patients with UI was higher than the control group, this difference was not statistically significant (P < 0.05). IL-22 immunoreactivity was observed in the endometrial glands and stromal tissues using IHC. We found the lowest IL-22 expression in the control group and the highest in uRPL samples (P < 0.05). Our findings suggest that a significant increase in IL-22 expression in uRPL patients may affect fertility and pregnancy outcomes or even have a considerable impact on immune function deficits. Further studies on the critical function of IL-22 during pregnancy are suggested.

Comparative study of Prophylactic Intravenous Ondansetron in the Attenuation of Post Spinal Hypotension versus Dexamethasone in Parturient Undergoing Caesarean Delivery

Abstract Background Spinal anaesthesia (SA) is the preferred anaesthesia technique for Caesarean section. Hypotension and bradycardia are the most common side effects encountered and are more pronounced in pregnant patients, the incidence being as high as 52.6% and 2.5% in normal patients. The occurrence of hypotension can be dangerous as it compromises placental circulation and can have a detrimental effect on the foetus. Objectives The purpose of this study is to assess the efficacy of ondansetron versus dexamethasone in decreasing incidence of spinal induced hypotension in parturient undergoing cesarean surgery. Patients and Methods This study was conducted at Ain Shams University Hospitals between March 2019 till September 2019. After approval is obtained from the research ethics committee of faculty of medicine, Ain Shams University &amp; patients’ informed consents consent from each patient after full explanation of the procedure possible side effects and complications., 75 healthy parturient, (ASA)physical status I and II undergoing elective cesarean delivery under spinal anesthesia. Results 8 mg ondansetron is more effective than 8 mg dexamethasone in the attenuation of post spinal hypotension. Also, that Dexamethasone 8 mg was as effective as ondansetron 8 mg in providing a simple, safe, cheap, and effective intra and postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden. Conclusion The present study demonstrated that, among patients who received spinal anesthesia with bupivacaine and fentanyl as adjuvant for elective for cesarean section, prophylactic intravenous 8 mg ondansetron compared to dexamethasone significantly decreases hypotension, HR fluctuation, yet the need for rescue doses for ephedrine were significantly higher in ondansetron.

Management of cesarean section in a patient with history of takotsubo cardiomyopathy-A case report

Takotsubo cardiomyopathy (TTCM), also known as stress-induced cardiomyopathy or “broken heart syndrome,” is a clinical entity characterized by acute left ventricular dysfunction and reversible cardiac failure in the absence of coronary artery disease. Obstetric patients with a history of peripartum TTCM pose a unique challenge to the anesthesiologist. With a multiplicity of issues to be considered and no recommendations for best practice, the management plan needs to be tailored for each parturient to minimize the stress associated with labor and delivery. We present the case of an apparently healthy parturient with a history of peripartum TTCM presenting for a subsequent cesarean section and outline the various issues an anesthesiologist might encounter.

ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine

Background:Studies have reported that the ED50 of intrathecal ropivacaine was increased when using prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. However, ED95 is more meaningful to clinical practice than ED50. Therefore, we conducted this study to determine the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine for cesarean section in parturients receiving prophylactic infusion of phenylephrine to prevent spinal-induced hypotension.Methods:A hundred of healthy parturients undergoing elective cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled in this randomized, double-blinded, dose-ranging study. Patients were randomly assigned to receive 7, 9, 11, 13 or 15 mg intrathecal hyperbaric ropivacaine respectively. The prophylactic phenylephrine infusion (50 μg/min) was initiated immediately at the same time of spinal injection. Successful spinal anesthesia was defined as a T5 sensory level achieved within 10 min after intrathecal drug administration and no epidural supplement was required during the surgery. The ED95 was calculated with Probit analysis.Results:The ED95 of intrathecal ropivacaine with 5 μg sufentanil for successful anesthesia was 15.2 mg (95%CI, 13.5–18.8 mg), when receiving prophylactic infusion of phenylephrine.Conclusion:Under the conditions of the present study, the ED95 of intrathecal hyperbaric ropivacaine for successful spinal anesthesia for cesarean section in healthy parturient receiving prophylactic infusion of phenylephrine was 15.2 mg.

Labor Epidural Intolerance Due to a Congenitally Narrowed Spinal Canal

Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis. We believe a similar mechanism may explain the pain that patients sometimes experience after administration of large epidural volumes.

Transient loss of voice during labour analgesia.

Sir, A 30-year-old full term American Society of Anesthesiologists 1 primigravida patient was administered labour analgesia (LA) on demand at 4-5 cm cervical dilation employing combined spinal epidural (CSE) technique. In sitting position, assuring asepsis, 18 g epidural catheter was sited in L2-3 space threaded up to 10 cm, checked and fixed. After that, 1cc of 0.125% preservative free isobaric bupivacaine (1cc of 0.25% preservative free bupivacaine double diluted with sterile normal saline) and 10 μg fentanyl was injected intrathecally via 26 g Quincke needle at L3-4 space. Maternal and foetal vital parameters remained stable. She had satisfactory pain relief in 10 min and was chatting comfortably when suddenly after 12 min, we noticed loss of voice (she was unable to talk). Other than that there was no neurodeficit or dyspnoea. Spinal level was limited to T6. She was fully awake, oriented and continued communication with us by writing. All maternal and foetal vital parameters remained normal. She was pain free and her labour progressed normally. She was worried but not hysterical. No further abnormality was revealed in neurology consultation. As no further deterioration was noted, we counselled the patient and relatives regarding this event being a rare but reversible drug side effect and reassured them about both maternal and foetal well-being. Epidural bolus was held off, which otherwise would be given at 30 min after spinal injection. By 45 min of the event the phonation started returning and by 1 h she was able to speak normally. Simultaneously cervix was found to be fully dilated and she went on to have a normal vaginal delivery. Ten millilitre 0.25% bupivacaine was given epidurally for episiotomy suturing. The epidural catheter was removed after suturing. The post-operative recovery, hospital stay and follow up for 3 months was uneventful. Cerebral complications of preeclampsia, thrombo-embolic phenomena, absence seizure or high spinal can mimic symptoms of transient ischaemic attack in a parturient. However, our patient did not fit into any of these categories. Kuczkowski and Goldsworthy[1] reported a case of a previously healthy parturient who received 10 μg of fentanyl combined with 2.5 mg of bupivacaine intrathecally as a part of CSE technique for LA and At 4 min after intrathecal injection she suddenly developed transient aphonia and aphagia. The pinprick sensory level of analgesia was found to be at T3 and her symptoms resolved in 20 min. Gupta et al.[2] reported aphonia and aphagia in a male patient posted for lower limb debridement at 3 min after receiving 12.5 mg heavy bupivacaine with 25 μg fentanyl intrathecally which recovered spontaneously in 10-15 min. In both cases the authors believe extensive cephalad spread of fentanyl through the Cerebrospinal fluid (CSF) as the cause for neurological symptoms. There has been a study which noted rapid cephalad spread of fentanyl in the cervical CSF after lumbar administration.[3] Sudden onset, life-threatening respiratory depression have been reported following administration of intrathecal fentanyl for labour analgesia which suggest that lipophilic opioids may move rapidly from lumbar cistern to brainstem level via CSF.[4] There may be more rapid rise in CSF concentrations of drug due to pregnancy related changes. Rapid clearance of fentanyl from the CSF might explain the transient nature of symptoms. Some cases have been reported where similar side effects were noted to be reversed using opioid antagonists naloxone and nalbuphine[5] supporting the cause to be the opioid. Many similar unreported incidences may have been attributed to over anxious and hysterical nature of patients. CSE using fentanyl is one of the established techniques for labour analgesia with minimal side effects. It is necessary to be aware of this rare side effect and maintain composure, provide reassurance to patient and reverse drug effect if needed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A comparative study of Intrathecal clonidine and fentanyl along with bupivacaine in spinal anesthesia for caesarean section

Background: Patients undergoing caesarean section under spinal anaesthesia often experience pain in the perioperative period. The aim of this study was to evaluate the effect of intrathecal combination of clonidine and bupivacaine compared with bupivacaine and opioid on the incidence and severity of pain in elective caesarean section cases. Materials and Methods: Ninety healthy parturient at term scheduled for elective caesarean delivery were randomly allocated to receive intrathecally hyperbaric bupivacaine alone (Group B) or combined with 75 μg of clonidine (Group C) or with fentanyl 25 μg (Group F). The peak sensory block level, time to reach peak block level from injection, time to two segment regression, maximum degree of motor block, side effects, perioperative analgesic requirements and time to the first analgesic request after surgery were recorded and statistically analysed. Results: Time to two segment regression was significantly prolonged in Group C (78.87 ± 13.362 mins.) and Group F (84.17 ± 12.463 mins.) as compared to Group B (69.70 ± 14.005 min); (P < 0.05). There was significant prolongation of postoperative analgesia as seen by the time to first analgesic request after surgery in Group C (3.550 ± 1.1013 hours) and Group F (5.183 ± 1.1706 hours) as compared to Group B (2.350 ± 0.9016 hours). (P < 0.05). There was increased incidence of hypotension and nausea in Group C compared to other two groups. Conclusion: Perioperative analgesia was prolonged by the addition of 75 μg of clonidine and 25 μg fentanyl to bupivacaine, with increased side effects of nausea, vomiting and hypotension in the clonidine group.

Lung Ultrasound Predicts Interstitial Syndrome and Hemodynamic Profile in Parturients with Severe Preeclampsia

The role of lung ultrasound has never been evaluated in parturients with severe preeclampsia. The authors' first aim was to assess the ability of lung ultrasound to detect pulmonary edema in severe preeclampsia. The second aim was to highlight the relation between B-lines and increased left ventricular end-diastolic pressures. This prospective cohort study was conducted in a level-3 maternity during a 12-month period. Twenty parturients with severe preeclampsia were consecutively enrolled. Both lung and cardiac ultrasound examinations were performed before (n = 20) and after delivery (n = 20). Each parturient with severe preeclampsia was compared with a control healthy parturient. Pulmonary edema was determined using two scores: the B-pattern and the Echo Comet Score. Left ventricular end-diastolic pressures were assessed by transthoracic echocardiography. Lung ultrasound detected interstitial edema in five parturients (25%) with severe preeclampsia. A B-pattern was associated to increased mitral valve early diastolic peak E (116 vs. 90 cm/s; P = 0.05) and to increased E/E' ratio (9.9 vs. 6.6; P < 0.001). An Echo Comet Score of greater than 25 predicted an increase in filling pressures (E/E' ratio >9.5) with a sensitivity and specificity of 1.00 (95% CI, 0.69 to 1.00) and 0.82 (95% CI, 0.66 to 0.92), respectively. In parturients with severe preeclampsia, lung ultrasound detects both pulmonary edema and increased left ventricular end-diastolic pressures. The finding of a B-pattern should restrict the use of fluid. However, these preliminary results are associations from a single sample. They need to be replicated in a larger, definitive study.

Evaluation of in vivo effects of Oxytocin on coagulation of parturient during cesarean delivery by thromboelastography.

Objective:Oxytocin routinely used as an uterotonic drug in cesarean delivery. Clothing problems, adverse effects on fibrinogen and bleeding were presented as side effects of oxytocin. In in vivo investigation, modest hypercoagulable state was suggested as a side effect for infusion of oxytocin in parturients. In this study, effects of two different infusion rates of oxytocin on coagulation of parturient were evaluated during cesarean delivery.Methods:In a randomized double-blinded clinical trial, 84 healthy parturient in two equal groups took oxytocin infusion with the rate of 15 IU/h (Group A) or 30 IU/h (Group B), after the umbilical cord clamping. Coagulation status measured 30 min after beginning of infusion by thromboelastography. Data were analyzed by χ2, paired sample test and ANOVA considering as significant at P < 0.05.Findings:The mean (standard deviation) of variables in Groups A and B were 2.4024 (0.86) and 2.0429 (0.68) for K (kinetics of clot development), 55.4429 (11.30) and 60.7595 (10.41) for α (speed of clot strengthening) and 59.779 (19.15) and 70.61 (11.30) for maximum amplitude (maximum clot strength), respectively. The P values for these variables were 0.036, 0.028 and <0.001, respectively; these changes are consistent with increasing coagulability. Other measures did not have significant differences.Conclusion:This in vivo investigation clarified that increasing infusion rate of oxytocin to 30 IU/h can augment coagulability in term parturients.

Absceso epidural y de psoas bilateral tras anestesia epidural obstétrica: una complicación poco frecuente

Epidural abscess is a rare but serious complication of epidural anesthesia. We present the case of a healthy parturient who developed spinal epidural and psoas muscle abscesses following spinal analgesia for uneventful labor and delivery. Diagnosis requires a high index of suspicion and magnetic resonance imaging. Early surgical decompression and prolonged antibiotic therapy are the mainstays of epidural abscess treatment, while percutaneous drainage under imaging guidance with antibiotic coverage is an effective front-line treatment of psoas muscle abscess. Epidural abscess can be a catastrophic consequence of epidural anesthesia. Early diagnosis is essential to prevent permanent neurological damage.

Remifentanil-nitroglycerin combination as an anesthetic support for ex utero intrapartum treatment (EXIT) procedure

A 21 year old healthy parturient was diagnosed as having a fetus with micrognathia. She was scheduled for an ex-utero intrapartum treatment (EXIT) procedure. General anesthesia consisted of remifentanil, nitrous oxide, and midazolam. Intravenous nitroglycerin was used for uterine relaxation. This technique offered hemodynamic stability and provided uterine relaxation that may be rapidly terminated. For the fetus, it provided excellent transplacental anesthesia. Supplemental direct fetal anesthesia is recommended to prevent the rapid decline of analgesia/anesthesia that occurs after placental separation.

Fulminant peripartum cardiomyopathy rescue with extracorporeal membranous oxygenation

We report the successful use of extracorporeal membranous oxygenation in a previously healthy parturient with fulminant peripartum cardiomyopathy. Native cardiac function recovered rapidly, with weaning from extracorporeal membranous oxygenation after only 68 h. This case highlights the potential of this lifesaving treatment, in appropriately selected patients, where death seems inevitable. No major complications of extracorporeal membranous oxygenation occurred in this patient.

Group A Streptococcus causing a life‐threatening postpartum necrotizing myometritis: A case report

During childbirth, group A Streptococcus (GAS) can cause a diverse spectrum of disorders ranging from asymptomatic infection to puerperal sepsis and toxic shock syndrome. We report on a healthy parturient who survived a life-threatening necrotizing myometritis due to GAS following an unremarkable spontaneous delivery. Approximately 29 h after an unremarkable spontaneous vaginal delivery, a generally healthy 28-year-old multiparous woman developed a life-threatening necrotizing myometritis due to GAS. The patient subsequently underwent a total abdominal hysterectomy. Following the surgery, she made a prompt and complete recovery. The course of this extremely rare complication might be so fulminant that the diagnosis is sometimes made after the patient cannot be saved. Clinicians should still consider GAS in life-threatening infections occurring during the perinatal period.

Posterior Reversible Encephalopathy Syndrome During Pregnancy: Seizures in a Previously Healthy Parturient

Posterior Reversible Encephalopathy Syndrome During Pregnancy: Seizures in a Previously Healthy Parturient