///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-06:00

A Case of Sepsis and ARDS Following Retained Products of Conception.

Abstract Number: 100
Abstract Type: Case Report/Case Series

Nader N Helmi DO1 ; Sabri Barsoum MD2; Juan Cata MD3

A 23 year old female, G1P0, at 18 weeks gestation presented with abdominal pain. She had a past medical history of chronic urinary tract infections. She was diagnosed with nephrolithiasis and oligohydraminos.

Three days later the patient was admitted for placement of a J-stent and a diagnosis of left ureteral calculus was made. She was then discharged three days later in stable condition.

Two days following the fetus was diagnosed with Potter Syndrome and determined to be nonviable. At this time a laminaria tent was placed to dilate her cervix and labor was induced. A lumbar epidural was easily placed without complications when the patient requested labor analgesia, cervix was at four centimeters of dilation. Approximately ten hours later the fetus and placenta were delivered intact. The patient complained of flank pain after delivery, this was attributed to her nephrolithiasis. The epidural was bolused with 5mL of 0.0625% bupivaciane and 2 mcg/mL fentanyl. She did not obtain pain relief from the bolus. The epidural was again bolused , again no pain relief was obtained. The epidural was then bolused with five mg of preservative free morphine. The catheter was then removed intact.

The patient remained in the hospital for two days due to pain control issues. A CT scan was performed that was negative for renal calculi and other abnormalities. She was discharged home in stable condition and her pain was controlled with oral oxycodone.

Twelve hours after discharge she presented to the emergency department with fever (39 C), rigors, chills, abdominal/flank pain. She was again admitted to the hospital and treated with IV levofloxacin and ampicillin/sulbactam. At this time her urine culture was positive for Escherichia coli all other cultures were negative throughout her hospitalization.

The next morning she underwent a dilation and curettage with a fair amount of products of conception removed from the cervical canal and her J-stent was removed. She then remained febrile and deteriorated clinically. Two days later, she was in respiratory distress requiring intubation and ICU admission.

The following morning she underwent a suction dilatation and curettage, minimal tissue was removed and approximately 300 mL of clotted blood was removed.

Over the next four days she required mechanical ventilation with high peep and high inspired oxygen. Her clinical state, ventilation requirements, arterial blood gases, and chest radiographs were consistent with sepsis and ARDS. Repeat cultures remained negative. She also required high doses of propofol and fentanyl infusions for agitation this was also supplemented with prn doses of midazolam.

On the fifth day of her supportive care, she began to improve and her mechanical ventilation support was carefully weaned. She was extubated seven days after intubation and transferred to the regular nursing floor. She was discharged home thirteen days later in good condition.

SOAP 2009