Mario Enmanuel López Marenco¹, Leslian Janet Mejía Gómez², Raúl Carrillo Esper³ and Brenda Paola Hernández Henríquez⁴*

¹Internal Medicine UNAN, Critical Medicine UNAM, Postgraduate Critical Medicine in Obstetrics UNAM, Critical Transthoracic and Transesophageal Echocardiography UBA Hospital Carlos Roberto Huembes, Managua, Nicaragua
²Specialist in Anaesthesiology, Anesthesia in the Polytraumatized Patient UNAM, High Specialty Medical Unit "Lomas Verdes" Trauma and Orthopedics IMSS, Nicaragua
³Head of Critical Areas, National Institute of Rehabilitation Academy of Medicine Mexican Academy of Surgery, Nicaragua
⁴Internal Medicine UNAN, Hemodialysis Unit, Hospital Monte España, Managua, Nicaragua

*Corresponding Author: Brenda Paola Hernández Henríquez, Internal Medicine UNAN, Hemodialysis Unit, Hospital Monte España, Managua, Nicaragua.

Received: March 08, 2023; Published: March 24, 2023

Abstract

A 25-year-old woman was admitted to the Intensive Care Unit for a 34.5-week gestation pregnancy and diabetic ketoacidosis associated with pyelonephritis. Laboratory tests: Hemoglobin 12.3 gr/dL Hematocrit 37.2%, Leukocytes 20,000 × 10⁹/L, Platelets 210,000 × 10⁹/L, Glucose 252 mg/dL, Urea 50 mg/dL, Creatinine 1.7 mg/dL, Uric Acid 7.2 mg/dL. The arterial blood gas shows a pH 7.1, base deficit -20, HCO3 4 mmol/L, lactate 1.5 mmol/L, PaO₂ 110 mmHg, PaCO₂; 21 mmHg and Oxygen Saturation 96%, ketonemia 50 mmol/L. General Urine Examination with proteins +++, abundant bacteria, positive nitrites, abundant leukocytes, ketonuria +++, glucosuria >1000.

Obstetrics confirms the diagnosis of Intrauterine Growth Restriction and rules out labor at this time. Blood Pressure is 80/62 mmHg, heart rate 110 beats per minute, Respiratory Rate of 25 breaths per minute, Temperature 36.8º Celsius, uterine fundus of 26 cm, does not perceive fetal movements, Fetal Heart rate of 170 beats per minute.

Hartmann's solution 1,000 ml intravenously, Ceftriaxone 1,000 mg intravenously every 8 hours and insulin infusion are administered. After 6 hours of driving, he found the following biochemical parameters: Glucose 180 mg/dL, Sodium 135 mEq/L, Potassium 3.4 mEq/L, Chlorine 102 mEq/L, Ketonemia 15 mmol/L, urea 30 mg/dL, creatinine 1.3 mg/dL, arterial blood gas pH 7.25, 12 mmol/L HCO₃, -12 base deficit, 0.9 mmol/L lactate, 95% oxygen saturation.

A new obstetric evaluation is requested to assess fetal well-being, the cardiotocographic record shows a silent trace, which suggests an immediate interruption of pregnancy via the abdominal route, a cesarean section is performed and death is found.

Keywords: Ketonemia; Intensive Care Unit (ICU); RCTG

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Citation: Brenda Paola Hernández Henríquez., et al. “Fetal Monitoring by Cardiotocography in the Intensive Care Unit". Acta Scientific Clinical Case Reports 4.4 (2023): 40-49.

Copyright: © 2023 Brenda Paola Hernández Henríquez., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.