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Progressive multiple organ dysfunction syndrome in adolescent pregnancy: Case report.

Jennifer Rodrigues Boock¹, Alexis Strickler¹, María Teresa Silva Elgueta¹

¹Departamento Pediatría, Facultad de Medicina y Ciencias Universidad San Sebastián sede de la Patagonia, Puerto Montt, Chile.

|October 13, 2023

Summary

Adolescent pregnancy complicated by pyelonephritis and sepsis can lead to severe maternal and neonatal outcomes, including progressive multiple organ dysfunction and chronic kidney disease. Prompt diagnosis and treatment are crucial to prevent mortality and long-term sequelae.

Keywords:

Acute kidney injury Multiple organ dysfunction syndrome Pyelonephritis Septic shock

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Area of Science:

Obstetrics and Gynecology
Nephrology
Intensive Care Medicine

Background:

Adolescent pregnancy, while physiological, carries risks of premature delivery and severe maternal/neonatal pathologies.
Pyelonephritis and sepsis during pregnancy can precipitate acute complications, including multiple organ dysfunction syndrome (MODS).

Observation:

A 14-year-old adolescent at 27 weeks gestation presented with preterm labor, pyelonephritis, and acute kidney injury, rapidly progressing to septic shock and MODS.
Despite intensive care, including mechanical ventilation and dialysis, the patient developed sustained organ failure over 28 days.
Preterm vaginal delivery occurred, resulting in a neonate with severe asphyxia, bronchopulmonary dysplasia, and hypoxic-ischemic encephalopathy.

Findings:

The adolescent developed chronic kidney disease stage KDIGO 5 and requires renal transplantation.
The case highlights the severe, progressive nature of MODS in complicated adolescent pregnancies.
Neonatal complications included severe asphyxia and hypoxic-ischemic encephalopathy.

Implications:

Timely diagnosis and management of pyelonephritis and septic shock in adolescent pregnancies are critical.
Preventing delays in treatment can avert mortality and permanent sequelae for both mother and child.
This case underscores the need for high-risk obstetric monitoring and intensive care for complicated adolescent pregnancies.