Dangerous

I heard a horrible story from a friend of mine who is an OB/GYN about a recent patient – in fact this patient is also an OB/GYN. She is in her mid thirties and completely healthy until she did something very dangerous – something that has killed untold millions of young women for centuries – had a baby. Yes, believe it or not, although it is “natural”, delivering a baby is potentially very dangerous. Death used to be common and accepted as recently as 80 years ago as an unfortunate complication of reproducing. Thankfully, it is much safer today in societies with modern medicine. Still, tragedies do happen. Here is one. This woman gave birth at full term to a healthy baby via uncomplicated vaginal delivery. She had a minor tear that was repaired and that was it. She was discharged the next day and felt fine. Three days later she came back to the ER with a fever of 103, heart rate of 150, and a systolic blood pressure of 80. Quickly she was given fluids and labs were sent, looking for a source of fever. She had no abdominal pain, no cough, no urinary symptoms, no rash that she noticed. Here labs were terrible. He WBC count was 22K with many bands, Her Bicarb was 7, and her creatinine was 5. Her liver was failing. She was in severe septic shock – and with no source. The urine was clean. Her uterus non-tender, her CXR normal, and had no meningeal signs. After starting several antibiotics and several pressors, she was intubated and went to the unit where she continued to decompensate. She had to be started on dialysis, she developed anasarca (massive total body edema), she was on 4 pressors including an Epi drip and her toes, fingers and tip of her nose became ischaemic and almost had to be amputated. Finally, the blood cultures grew out Group A strep (the same thing that causes strep throat) – which can cause TSS (toxic shock syndrome) after childbirth (as opposed to Staph that tends to cause it from tampons). Her vaginal tear was examined more closely and there was a small area that looked a little necrotic so she was taken to the OR for debridement. Luckily only a small patch had to be debrided – and that seemed to be the source of the infection.

2 weeks later she is has finally slightly improved. She extubated herself and is mentating and on only dopamine for BP support. Her liver is improving – but her kidneys have not yet. She is not out of the woods and everyone is just hoping she makes a meaningful recovery – if she ever recovers enough to go back to work, it would be a miracle.

GYN, Infectious Disease, Sad, Shocking, Surgery | RSS 2.0 | Respond | Trackback |