Double duty: Successful management of a late second trimester severe burn

Background

Thermal burns during pregnancy are rare but life-threatening emergencies associated with significant morbidity and mortality. Currently, principles of management center around fluid resuscitation based on formulas established for nonpregnant patients and supportive care, as data on the optimal management of pregnant burn patients is limited.

Case report

We present the case of a 23-year-old G2P1 at 26 weeks gestational age who presented to the emergency department with 52 % total body surface area (TBSA) burns and inhalation injury sustained during a house fire. She was initially managed with both standard burn fluid resuscitation and vasopressors to maintain perfusion before undergoing an emergent delivery 3 h after her initial presentation. Ultimately, she underwent five surgical debridements with split-thickness skin grafting before being discharged on hospital day 60. Her infant was treated for prematurity-associated respiratory distress syndrome and was discharged on hospital day 82 without any other major complications.

Why should an emergency physician be aware of this?

Thermal burns in pregnancy are high-risk, low-frequency events that require the competent, rapid consideration of numerous factors to optimize outcomes for both the mother and fetus. This case describes the effective management of maternal hemodynamics with early standard fluid resuscitation and vasopressors, though highlights the need for future studies identifying the role of fluids and vasopressors in supporting pregnant patients with burn injuries and their fetuses.