not very much info for a diagnosis, but i think of placental abruption when i hear severe abd pn and pregnant pt
I had a feeling this was answer seeking.
Just curious what part of that presentation you feel indicates cardiomyopathy?
A number of years ago I did my CNM training and one of the things that we learned about that is really and truly different in pregnancy versus non-gestational times is cardiomyopathy. While it is not super common, it is most likely in the last eight weeks and this woman has some indications for sure that things are not right based on vitals She has a history of hypertension but her bp isn't THAT bad, her respirations are certainly trying to compensate for something but we don't know the rhythm and quality of them. However, most concerning to me would be the severe abdominal pain with the absence of any type of contractions or bleeding....abruptions do not generally cause that described type of pain, at least not until the bleeding inside the uterus is enough to cause pressure-type pain, at which point it certainly would be unrelenting pain and eventually excruciating, as the pressure builds and builds. Abruptions sometimes cause bleeding (most EMS texts will say usually, but in the world of obstetrics it is much less likely that you would think), more so if there is a previa that has a full or partial abruption but there is no complaint of bleeding. While we don't see a whole lot of MI's in pregnant women who have no previous medical history of heart disease, when we do it can very often present as abdominal pain rather than chest pain.
Beyond that, I really don't know. It was what popped into my head when I read the scenario. Perhaps because I was so fore-warned of it in midwifery school that I also tend to be on the cautious side regarding it but the constant abdominal pain raised a flag. One thing that I would also be sure to ask if I were on scene would be prior c/s hx. Uterine tearing would present like this.
CNM huh? Interesting. Thanks for the info.
What would you have leaned towards in this scenario?
Sounds like HELLP syndrome...Glad she's okay!I can tell you from personal experience with a spouse who was preeclamptic that this could be as simple as progressive liver failure. When the protein in a clean catch urine skyrockets the woman can rapidly go into liver failure (12-16 hours) with severe ruq abd pain only relieved by narcotics most of the time. On Friday my wife was fine on bed rest with elevated protien. On Saturday her protien had almost 7X and she was in constant severe pain...then a c section. She never had seizures even in liver failure and her bp was fairly regularly controlled.
Just a possibility