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Ǵм Yeungnam Univ J Med 2018;35(1):84-88

CASE REPORT

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

Moni Ra1, Myungkyu Kim1, Mincheol Kim1, Sangwoo Shim1, Seong Yeon Hong2
Departments of 1Internal Medicine and 2Obstetrics and Gynecology, Catholic University of Daegu School of Medicine, Daegu, Korea
Corresponding Author: Sangwoo Shim, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea
Tel: +82-53-650-4274, Fax: +82-53-621-4106
E-mail: swshim@cu.ac.kr

Received: August 6, 2016, Revised: October 30, 2016 Accepted: Accepted: October 31, 2016

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.

Key Words: Keywords: Infectious pregnancy complications; Sepsis; Infection

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