Septic shock resulting in death after operative delivery

We report a young woman who developed septic shock after operative delivery in the 32nd week of pregnancy. Clinical features, treatment modalities and prognosis of this high-mortality-rate disorder are presented and discussed.

A 24-year-old woman, gravida 1, para 1, was referred to our clinic in a confused state and immediately admitted to our emergency unit. She apparently had eclampsia antenatally. Termination of pregnancy with induction of labor and vacuum extraction had been employed in gestational week 32 of pregnancy. One day after delivery, her clinical and laboratory parameters worsened, so she was referred to our clinic. After a thorough physical examination and laboratory evaluation, the patient was diagnosed as having sepsis and disseminated intravascular coagulation. After blood and urine cultures were taken, aggressive management included volume repletion, antibiotics and positive inotropic therapy. Because she had persistent fever and unimproved laboratory values despite these therapies, the uterus and ovaries were thought to be the source of sepsis, and total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Neither clinical nor laboratory parameters improved, and the patient died 28 days after delivery as a result of respiratory failure.

It is our purpose to emphasize that a rapid and appropriate decision for surgery may prevent the maternal mortality in obstetric septic shock patients. Successful management depends on early identification and aggressive treatment.