Successful prone positioning after recent caesarean section in severe ARDS with postpartum pulmonary haemorrhage

A 35-year-old Thai women (gravida 3, para 0) at 36 weeks and five days of gestation was admitted to a delivery room due to premature rupture of membrane. She was diagnosed with Escherichia coli with extended-spectrum beta-lactamase (ESBL) chorioamnionitis and septic shock leading to signs of fetal distress. She underwent emergency caesarean section. Post-operatively, the patient developed severe acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), massive pulmonary haemorrhage, and intra-abdominal bleeding. Lung protective strategy and recruitment manoeuvres were applied; however, her oxygenation and haemodynamic parameters worsened. Twenty consecutive hours of prone positioning was performed as a rescue procedure to improve patient's oxygenation and allow the patient to undertake surgical re-exploration for abdominal compartment syndrome management safely. Neither high ventilator setting nor re-positioning was needed after the second operation.