Background and Aims Lipodystrophic syndromes are congenital or acquired disorders, characterized by complete or partial lack of adipose tissue. Apparent accumulation of fat in other regions of the body may be present. Metabolic complications resulting from lipodystrophy are severe insulin resistance, hyperlipidemia, progressive liver disease and increased metabolic rate. Treatment with leptin has been suggested with a potential role for both metabolic and reproductive health. We present a case of a parturient with lipodystrophy that underwent caesarean section.
Methods A 36 y G1P0 parturient with a history of congenital lipodystrophy, DM-1 since early childhood, hypothyroidism and hypertension during pregnancy was admitted. She had undergone partial lobar hepatectomy in the past. Before conception the patient had received leptin injections. Swollen lower extremities, hypertension (average BP 160/90) and increased urine protein were indicative of preeclampsia. At 33 weeks gestation signs of retinal detachment suggested caesarean section delivery. C-section was scheduled at 37 weeks. Preoperative BP was 184/95, HR 85, Sp02 98%. Epidural anaesthesia was chosen.
Results A total of 6 mL Lidocaine 0.2% (120 mg), 13 mL Ropivacaine 0.75%(97.5mg) and 50mcg Fentanyl were given through the epidural catheter achieving a T-4 anaesthetic level. BP was 150/80 until delivery and normal 120/80 afterwards. Oxytocin 5 iu bolus plus infusion was given as uterotonic. A solution of 0.15% ropivacaine with 2mcg/ml fentanyl in total of 200 ml was administered as post-caesarean section analgesic regimen.
Conclusions The choice of epidural anaesthesia for caesarean section in the rare case of a woman with lipodystrophy and hypertension during pregnancy was safe and efficacious.
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