A successful management after preterm delivery in a patient with severe sepsis during third-trimester pregnancy
10.12701/yujm.2018.35.1.84
- Author:
Moni RA
1
;
Myungkyu KIM
;
Mincheol KIM
;
Sangwoo SHIM
;
Seong Yeon HONG
Author Information
1. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. swshim@cu.ac.kr
- Publication Type:Case Report
- Keywords:
Infectious pregnancy complications;
Sepsis;
Infection
- MeSH:
Acute Kidney Injury;
Adult;
Anoxia;
Anti-Bacterial Agents;
beta-Lactamases;
Blood Pressure;
Body Temperature;
Cesarean Section;
Dyspnea;
Dysuria;
Emergency Service, Hospital;
Escherichia coli;
Female;
Fetal Distress;
Fever;
Gestational Age;
Heart Rate;
Hematuria;
Humans;
Inhalation;
Intensive Care Units;
Intubation, Intratracheal;
Lung;
Methicillin-Resistant Staphylococcus aureus;
Oximetry;
Oxygen;
Partial Pressure;
Pneumonia;
Pregnancy Complications, Infectious;
Pregnancy;
Pyuria;
Respiration, Artificial;
Respiratory Insufficiency;
Respiratory Rate;
Respiratory Sounds;
Sepsis;
Sputum;
Thorax;
Thrombocytopenia;
Urinalysis;
Urinary Tract Infections;
Uterine Contraction;
Vital Signs
- From:Yeungnam University Journal of Medicine
2018;35(1):84-88
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature 38.7℃, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.
