一例罕见的妊娠中期胎膜早破后胎儿气性坏疽的计算机断层扫描诊断

IF 0.2 Q4 ANESTHESIOLOGY
K. Gupta, A. Ajith Kumar, Modhulika Bhattacharya, P. Murthy, K. Sarath
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引用次数: 0

摘要

引言:报告一例罕见的胎儿气性坏疽,在计算机断层扫描的帮助下,在妊娠中期胎膜早破。病例报告:一位33岁的女士,G4A2L1,预约并接种了疫苗,在妊娠25周时出现胎膜早破。经过静脉注射抗生素和密切监测,她在第四天晚上出现了严重的腹痛和高烧。由于出现了新发的休克,她被转诊到产科护理室的上级中心。急诊室对腹部和骨盆的超声波检查排除了休克的其他原因,但证实了宫内死亡。在计划阴道分娩后,她的病情进一步恶化,需要插管和血管升压药。腹部和骨盆的对比增强计算机断层扫描(CECT)显示胎儿气性坏疽和双侧急性皮质坏死。紧急子宫切除术,在高风险同意下进行,产下浸渍胎儿。她患有无张力子宫,需要在全身麻醉下进行产科子宫切除术(GA)。她的产后过程因弥散性血管内凝血(DIC)、急性呼吸窘迫综合征(ARDS)和多器官功能障碍综合征而复杂,需要多次输血、俯卧通气和多器官支持。然而,她无法抢救,在手术的第二天就去世了。结论:我们描述了一例罕见的致命胎儿气性坏疽病例,该病例在妊娠中期通过腹部和骨盆的计算机断层扫描(CT)诊断为胎膜早破。CT扫描可以可靠地识别羊膜腔和胎儿部位的肺气肿变化,这有助于从引产到早期手术方法的决策,以预防腹膜炎和多器官衰竭。我们建议在妊娠合并宫内感染和休克的情况下进行早期CT扫描,这可能会改变治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A rare case of fetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography
Introduction: To report a rare case of foetal gas gangrene following premature rupture of membranes in the second trimester diagnosed with the aid of computed tomography. Case Report: A 33-year-old lady, with G4A2L1, booked and vaccinated, developed premature rupture of membranes at 25 weeks of gestation. She developed severe abdominal pain with high-grade fever on the fourth night after expectant management with intravenous antibiotics and close monitoring. As there was a new-onset shock, she was referred to the higher centre from the obstetric care unit. The ultrasound of the abdomen and pelvis in the emergency room ruled out other causes of shock but confirmed intrauterine death. After planning for vaginal delivery, she had further deterioration requiring intubation and vasopressors. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis was performed which showed foetal gas gangrene and bilateral acute cortical necrosis. Emergency hysterotomy, performed under high-risk consent delivered macerated foetus. She had atonic uterus and required obstetric hysterectomy under general anaesthesia (GA). Her post-partum course was complicated by disseminated intravascular coagulopathy (DIC), acute respiratory distress syndrome (ARDS) and multiorgan dysfunction syndrome requiring multiple transfusions, prone ventilation and multiorgan support. However, she could not be salvaged and died on the 2nd day of surgery. Conclusion: We describe a rare fatal case of foetal gas gangrene in the second trimester following premature rupture of membranes which was diagnosed by a computed tomography (CT) scan of the abdomen and pelvis. The CT scan reliably identifies emphysematous changes in the amniotic cavity and foetal parts which helps in decision-making from the induction of labour to early surgical approach to prevent peritonitis and multiorgan failure. We recommend early CT scan in pregnancies complicated by intrauterine infections with shock which can change the line of management.
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