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Table 1: Timeline. |
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Date |
Medical and surgical events |
Details |
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21/07/2012– 24/09/2012 |
Prenatal consultations |
The patient received 7 prenatal consultations. No intercurrences |
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2/08/2012 |
Cardiology evaluation |
The physical examination found a normal NIBP and HR; absence of cyanosis and jugular-vein distention and rhythmic heart sounds with a reinforcement of the second in aortic focus. The electrocardiogram showed sinus rhythm, with a 60o axis and premature ventricular contractions alternated with normal beats |
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17/08/2012 |
Transthoracic color Doppler echocardiography |
Aortic dilation was evident from the root to the ascending portion. See details in diagnostic evaluation part |
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15/09/2012 |
Risk assessment |
Class II of the Goldman index was assigned, and recommendations were made for the intraoperative period: avoid adrenergic and overhydration, provide antihypertensive measures, and conditional use of amiodarone for treating extrasystoles |
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25/09/2012 |
Medical board |
The patient was scheduled for elective surgery with the following suggestions: continue with cardiological indications, prepare the availability of compatible red blood cell concentrate and ICU accommodation for postoperative monitoring |
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26/09/2012 |
Cardiology evaluation |
The Goldman classification and indications of the previous consultation were identical because the echocardiogram findings did not evidence risk at cardiac function |
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29/09/2012 |
Color Doppler ultrasound |
A single pregnancy of 33.5 weeks was found by fetal biometrics, normal Doppler flows (umbilical and middle cerebral arteries), and a small fetus for gestational age |
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10/10/2012 |
Preoperative anesthesia evaluation |
Airway evaluation: permeable, complete dentition, class II of modified Mallampati, central trachea, thyromental distance > 6 cm, interincisor distance > 5 cm |
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11/10/2012 |
Cesarean section |
She was in PACU for 3 hours, then went to ICU for monitoring and management. Four doses of cefazolin 2 g EV were completed every 6 hours and then the therapy was discontinued |
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12/10/2012 |
ICU discharge |
She was hospitalized in general ward |
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15/07/2012 |
Hospital discharge |
She received medical indications but there were no appointment dates for Cardiology and Gynecology offices at medical record |
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21/10/2012 |
Reentering by the Emergency Service |
She was admitted to trauma shock unit with a diagnosis of distributive (septic) vs cardiogenic shock |
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22/10/2012 |
Readmission to ICU |
The dead of the patient occurred |
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NIBP = non-invasive blood pressure; HR = heart rate; ICU = Intensive Care Unit; PACU = Postanesthesia Care Unit. |
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