Severe Sepsis After Vaginal Delivery: A Case Report.

Abstract

Background: Complications of pregnancy and childbearing are one of the most important public health concerns worldwide. Postpartum sepsis remains a leading cause of maternal morbidity and mortality. Early recognition and timely intervention, including surgical source control, when necessary, are critical for improving outcomes.

Case presentation: We report a 29-year-old gravida 2 woman with a history of opioid use, malnutrition, and very low socioeconomic status. She presented 10 days after a preterm vaginal delivery at 24 weeks' gestation with severe sepsis. She developed refractory septic shock, with evidence of endometritis, salpingitis, empyema, and renal microabscesses. Blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Despite aggressive fluid resuscitation and broad-spectrum antibiotics, her condition deteriorated, necessitating a total abdominal hysterectomy with bilateral salpingectomy and chest tube insertion on postpartum Day 14. The patient improved postoperatively and was discharged 14 days after surgery.

Discussion: This case highlights the importance of early recognition of postpartum sepsis, rapid initiation of empiric broad-spectrum antibiotics, and multidisciplinary management. Risk factors such as comorbidities, malnutrition, and low socioeconomic status may increase disease severity and complicate management. In cases unresponsive to medical therapy, surgical source control can be lifesaving, even following vaginal delivery.

Conclusion: Clinicians should maintain a low threshold for aggressive intervention in high-risk postpartum patients. Early diagnosis, multidisciplinary care, and timely surgical intervention are key to reducing maternal morbidity and mortality.