Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 3 , Pages 267-269, September 2005

Massive Ascites Complicating Pre-eclampsia

  • Lee-Wen Huang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Jier-Zen Chang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Ling-Wei Huang

      Affiliations

    • Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
    • ,
  • Jiann-Loung Hwang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • ,
  • Hun-Shan Pan

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr. Hun-Shan Pan, Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, 95 Wen-Chang Road, Taipei 111, Taiwan

Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan

Received 20 October 2004; received in revised form 8 December 2004; accepted 5 February 2005.

Article Outline

Summary 

Objective

We report a case of a woman 27 weeks into her pregnancy with severe pre-eclampsia complicated by severe ascites diagnosed using ultrasonography and managed with paracentesis.

Case Report

A 41-year-old woman, gravida 5, para 2, abortus 2, was referred from a prenatal clinic due to pre-eclampsia and complaints of headaches, blurred vision, and abdominal discomfort. In spite of treatment with hydralazine and magnesium sulfate and an albumin infusion, she developed orthopnea and abdominal distension. During ultrasound, severe maternal ascites of about 2,000 mL was discovered. Paracentesis was performed at 27+3 weeks. After the procedure, there was significant improvement in the patient's symptoms. However, complaints of abdominal distension and difficulty breathing recurred in week 31. Repeat paracentesis was performed followed by administration of corticosteroid for fetal lung maturation. At 31+3 weeks, the baby was delivered by cesarean section due to progressive toxemia and intrauterine growth retardation. During the operation, 1,500 mL of ascitic fluid was aspirated from the pelvic cavity. A female neonate was delivered with a birth weight of 1,020 g and Apgar scores of 6 and 8 at 1 and 5 minutes, respectively. At the 6-week follow-up, the patient was well and normotensive, and the baby was discharged from the neonatal intensive care unit.

Conclusion

Clinicians should be aware of the possible presence of ascites in patients with severe pre-eclampsia. If the hypertension is controlled and the fetus is healthy, abdominal paracentesis without pregnancy termination is an efficacious procedure for the management of massive ascites complicating severe pre-eclampsia.

Key Words:  massive ascites , paracentesis , severe pre-eclampsia

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Cong KJ , Wang TT . Complication of ascites in pregnancy-induced hypertension . Zhonghua Fu Chan Ke Za Zhi . 1994;29:7–9 [In Chinese]
  2. Vaijyanath AM , Nayar B , Malhotra N , Deka D . Massive ascites in preeclampsia: a rare complication . J Obstet Gynecol Res . 2002;4:199–202
  3. Golden A . Ascites in pregnancy . Am J Obstet Gynecol . 1959;57:385–387
  4. Semshyn S . Ascites in toxemia . Am J Obstet Gynecol . 1977;129:925–926
  5. Sullivan JM . In: Hypertension and Pregnancy . Chicago: Year Book; 1986;p. 73–81
  6. Foreman CS . Massive ascites as a rare complication of severe preeclampsia – a case report . J Reprod Med . 1989;34:307–310
  7. Brown MA , Zammit VC , Lowe SA . Capillary permeability and extracellular fluid volumes in pregnancy-induced hypertension . Clin Sci . 1989;77:599–604
  8. Lilford RJ , Lubbe WF . Multiple serous effusions complicating preeclampsia: a case report . S Afr Med J . 1978;54:619–621
  9. Page EW . On the pathogenesis of preeclampsia and eclampsia . J Obstet Gynaecol Br Commonw . 1972;79:883–888
  10. Woods JB , Blake PG , Perry KG , Magann EF , Martin RW , Martin JN . Ascites: a portent of cardiopulmonary complications in the preeclamptic patient with the syndrome of hemolysis, elevated liver enzymes and low platelets . Obstet Gynecol . 1992;80:87–91
  11. Calvin S , Silva M , Weinstein L , Finley P , Witte M . Characterization of ascites present in cesarean section . Am J Perinatol . 1991;8:99–102
  12. Woo JS , Liang ST , Wong VT . Ultrasonic detection of maternal ascites in patients with severe preeclampsia . Aust NZ J Obstet Gynaecol . 1982;72:237–239

PII: S1028-4559(09)60151-0

doi:10.1016/S1028-4559(09)60151-0

Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 3 , Pages 267-269, September 2005

Article Tools