24 yo G2P0101 35.3 weeks, H/O C/S due to Eclampsia at 30 weeks in prior pregnancy.
Presented overnight with cough and dyspnea x 1 week (tx'd with Keflex by UC on 3/25/20) and headache. Noted to have severe preeclampsia (by BPs), and AFI of 0 with umbilical artery S/D 2.09 (I'm presuming PPROM, she has been coughing so much that she can't distinguish urine leak vs LOF). Temps 98-99.2, Sats 96-98% on RA. Flu A/B, RSV neg, COVID-19 swab pending. WBC 10.4 (70% PMNs, 3% bands, 19% lymphs), no HELLP. Elevated LDH (277), low procalcitonin (0.9), Ferritin wnl (18.2). CXR with pulmonary edema vs ARDS.
She received Magnesium for seizure px on admission, which I have now stopped. She'll be going for repeat C/S due to prolonged PPROM, severe (worsening) preeclampsia.
Our ID recommends considering her positive (not just PUI) which we are doing (and with which I fully agree).
Presuming she's not intubated post-op, would you load with Keppra for seizure px but not continue dosing after initial load? Load then continue? For how many days? Use Dilantin or another antiepileptic? Just monitor for neuro sx? I'm leaning towards Keppra load, just wanted other opinions. (If intubated, I presume the sedation should take care of the need for seizure px.) TIA.
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Ginni S. Rosenfeld, MD
(solo MFM, in Los Angeles County)
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