Case report of eclampsia complicated with spontaneous splenic rupture

Abstract

Objectives We present a case report of eclampsia complicated with spontaneous rupture of spleen. Design A case report and literature search. Setting Queens hospital Burton on Trent. A 33 year old primigravida under low risk care presented to A&E at 38 weeks of gestation after suffering two eclamptic fits. On presentation her G. C. S was 8, B. P was 177/109 mmHg and she was oliguric. The fetal heart rate was 125 beats /min and her bishops score was 2. Magnesium sulphate and labetalol infusion was commenced. Blood results showed Hb 11.7 g/dl, Platelets -134 109/ l, mmol/l, ALT 399 IU/l and raised urea and creatinine. On maternal stabilisation category 1 caesarean section was called for fetal bradycardia. On delivery of sadly a pale stillborn baby, the blood pressure crashed leading to a peri-arrest situation. Profuse bleeding was noted from a large laceration on the dorsal surface of the spleen and a splenectomy was performed by the surgical team. Result The parturient's recovery was complicated with effects of massive blood transfusion, coagulopathy and acute renal failure. Three hepatic sub capsular haematomas were discovered on further imaging which resolved spontaneously. She recovered fully and was discharged home after 4 weeks in hospital. Conclusion Spontaneous splenic rupture in pregnancy without antecedent trauma is rare and is lethal complication of preeclampsia. The first case was reported by saxtroph in 1803. A previous study by Denehy et al, demonstrates that only 2.2% of 89 cases of splenic rupture in pregnancy were documented to be spontaneous in the puerperium.