Yeungnam Univ J Med.  2018 Jun;35(1):84-88. 10.12701/yujm.2018.35.1.84.

A successful management after preterm delivery in a patient with severe sepsis during third-trimester pregnancy

• Ra M
• Kim M
• Kim M
• Shim S
• Hong SY

• KMID: 2415738
• DOI: http://doi.org/10.12701/yujm.2018.35.1.84

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.

Keyword

Infectious pregnancy complications; Sepsis; Infection

MeSH Terms

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
Anti-Bacterial Agents
Oxygen
beta-Lactamases

Figure

• 

  Fig. 1. The initial chest X-ray showed pneumonic consolidations in both lung fields.

• 

  Fig. 2. Chest computed tomography scan showed diffuse patchy consolidations with air bronchograms and mild interlobular septal thickening in both lungs.

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