Posterior reversible encephalopathy syndrome is an uncommon finding following eclamptic seizures and subsequent fetal demise in a previously healthy primigravida.
A primigravida at term with no complicating factors in her pregnancy suffered an eclamptic seizure at home and was admitted to the closest healthcare facility in hypertensive crisis. She suffered another seizure upon her arrival and was subsequently diagnosed with an intrauterine fetal demise. She initially received intravenous magnesium sulfate, intravenous hydralazine, and intravenous labetalol to treat her hypertensive crisis. She was started on oxytocin to induce vaginal birth and an epidural catheter was placed for labor analgesia. During this time, she underwent a head computed tomography, which revealed extensive abnormalities in both the cerebral hemispheres consistent with posterior reversible encephalopathy syndrome. The patient spoke Spanish as her primary language and was lethargic for most of the first 24 hours of hospitalization, arousing briefly only to answer simple questions. The patient was transferred prior to active labor to the intensive care unit where she was monitored for possible neurologic deterioration. A labor and delivery nurse accompanied the patient, managed her oxytocin infusion, and supported her through a vaginal delivery of a stillborn fetus. The patient had significant but lessening neurologic deficits by time of discharge.
By analyzing and assessing patient data, observing, and planning, a safe outcome for this patient was affected. Obstetric and critical care nurses coordinated patient-specific interventions to direct outcomes and worked together to re-evaluate patient stability.