A 41-year-old G2P1 with a history of chronic hypertension, obesity (BMI 45), lower extremity edema, and asthma presents with severe-range blood pressures at 37 weeks gestational age. The diagnosis of preeclampsia with severe features is confirmed, an induction of labor is started, and an early epidural is placed due to prior cesarean/TOLAC. Four hours later, the patient is febrile to 101.4°F, tachypneic, oliguric despite fluids, and concern is raised for sepsis. Fetal heart monitoring is progressively non-reassuring, and the decision is made to pursue repeat cesarean delivery under epidural. Immediately following delivery, the patient develops hemodynamic instability and general anesthesia is induced. Point-of-care ultrasound (POCUS) identifies a hyperdynamic and underfilled heart with grossly normal biventricular function. Massive hemorrhage is identified and treated, and the patient experiences a full recovery.
Depending on your experience and practice, this case may induce emotions ranging from anxiety to terror. The rate of maternal...
