PULMONARY HYPERTENSION DURING PREGNANCY: A CRITICAL TIME Anthony Yey, Suzanne Cooper, Manpreet Singh, Michael B Fashho; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: Pulmonary hypertension during pregnancy is one of the highest risk medical conditions for both the mother and the fetus, with mortality rates reported to be as high 56%. Pulmonary hypertension mortality has been increasing in the United States (5.5/100,000 in 2001 vs 6.5/100,000 in 2010), however, rates are higher in women. Additionally, women account for 63% of the hospitalizations due to hypertension, which has increased 57% from 2001 to 2010. The World Health Organization (WHO) categorizes pulmonary arterial hypertension as a class IV heart disease and advises against pregnancy. However, pregnancies with pulmonary arterial hypertension are still increasing. Most common complications include fetal growth restriction, preterm birth, and fetal loss. Case: A 27-year-old female, G7P4, with a history of essential hypertension, ESRD due to hypertensive nephropathy and on dialysis, and IUP at 8 weeks GA by U/S, presented as a transfer for shortness of breath and dialysis on a cardene drip. Patient only found out she was pregnant 3 days prior to presentation. Physical exam was significant for coarse
breath sounds bilaterally, a systolic murmur, and fetal tones present. Lab work revealed a BNP of 4567 with negative troponins. TTE showed a pulmonary artery pressure of 66 mmHg. Patient underwent a right heart catheterization which showed pulmonary artery pressure of 45/15, with a mean PA pressure of 30-33. Patient’s hypertension has been difficult to manage even while on dialysis, Cardene drip, nifedipine, labetalol, and hydralazine. Maternal fetal medicine highly recommended termination of pregnancy due to the major complications that could arise in the third trimester. Since the patient is in early pregnancy and understands her high risk pregnancy, the patient has agreed to undergo a medical abortion with a dilatation and curettage. Discussion: This case presentation highlights the importance of close follow up in the outpatient setting. Patients who can become pregnant should screened for contraception usage. In patients with high-risk pregnancies and who desire to become pregnant, they should be worked up prior to conception.
ACUTE RESPIRATORY FAILURE SECONDARY TO ENDOMETRIAL CARCINOSARCOMA Suzanne Cooper, Ali Yousuf, Joseph Hennig, Ibrahim Shenawi, Jodi Rosson; Department of Medicine, LSU Health Sciences Center, Lafayette, LA.
Introduction: Uterine carcinosarcomas are rare, aggressive tumors that account for less than 5% of all uterine malignancies and are associated with poor prognosis, even when identified and treated at an early stage. Studies have shown that these tumors often invade into lymphatic and vascular spaces but there is limited data suggesting malignant central airway obstruction leading to acute respiratory failure.
for transfusion of blood products and further workup of AUB with concern for malignancy. A D&C with hysteroscopy was performed successfully. Overnight, the patient began to show signs of respiratory distress and the next day stridor and use of accessory muscles were noted upon examination. She also had new left- sided neck swelling. She rapidly required intubation after failing trial of BiPAP and ephedrine/Decadron. A CT scan of the neck showed bulky lymphadenopathy compressing the trachea. The patient was upgraded
Case: We present a 62-year-old female with breast cancer status post radiation, chemotherapy, and tracheostomy due to H1N1 with revision in 2020. She presented with complaints of shortness of breath and abnormal uterine bleeding over the past two years. The patient followed up with gynecology for work up of AUB and had previously undergone endometrial biopsy without success. On presentation her hemoglobin was found to be 6.7. She was admitted
to the ICU for closer monitoring. Differential diagnosis of the airway obstruction included hematoma from a reported difficult intubation vs. malignancy. She was given Solumedrol and daily cuff leak tests by respiratory therapy, which found no leak. Discussions were had with Radiation Oncology about debulking with palliative radiation. However, it was determined that cytology had to 22
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