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BACKGROUND: Amniocentesis is commonly performed to obtain a prenatal diagnosis. The most common indications for amniocentesis are abnormal foetal ultrasonography findings, followed by an increased risk of Down syndrome and advanced maternal age. The incidence of intra-amniotic infection is approximately 0.1%, and the risk of subclinical infection development after serial amniocentesis is no more than 0.5%. Septic shock is an unusual complication among cases of foetal loss associated with amniocentesis. Here, we report two cases of septic shock and multiple organ failure (MOF) after amniocentesis at mid-gestation. PRESENTATION OF CASES: Two women underwent genetic amniocentesis due to chromosomal aneuploidy. Prior to amniocentesis, the temperature, routine blood count, CRP and ultrasound findings were all normal. Genetic amniocentesis was performed under sterile conditions and without difficulty at 3P.M. A 22-gauge needle was passed into the right lower quadrant of the uterus, and 30 mL of clear fluid was extracted during the first attempt. They all complained of fever and chills and presented to the hospital within 48 hours after the amniocentesis. Foetal demise was found, and the patients rapidly developed septic shock. Despite vaginal delivery, curettage and antibiotic therapy, the patients deteriorated with the onset of MOF (myocardial damage, hypotension, renal insufficiency, low platelets). Blood cultures, discharge cultures and some tissue from the foetus all revealed Escherichia coli. The foul-smelling placenta was evacuated. There was gradual improvement with intensive monitoring. CONCLUSION: Uterine infection after amniocentesis leading to maternal sepsis is associated with a high morbidity and mortality rate. Our patients were able to survive without a hysterectomy due to the rapid administration of antibiotics and surgical intervention while being evaluated. Genetic counsellors and obstetric care providers should be aware of potential serious maternal morbidity and mortality that may occur subsequent to uncomplicated amniocentesis.

Background: To evaluate the success rate of Bakri balloon tamponade (BBT) and the risk factors for BBT failure in the treatment of intraoperative and postpartum hemorrhage (PPH) in patients with placenta previa. Methods: Patients with placenta previa who underwent cesarean section and had BBT insertion for PPH were consecutively included from 2016 to 2018. Patients with placenta previa who successfully underwent routine insertion of a BBT during cesarean section and had their bleeding controlled were classified as the balloon success group. Patients who successfully underwent BBT during cesarean section but continued to have uncontrolled bleeding were classified as the balloon failure group. Multiple logistic regression was performed to examine the risk factors for BBT failure. Results: During the study, 270 women with placenta previa were identified. The success rate of BBT for managing PPH was 69.3%. The balloon failure group (n = 83) comprised those who had undergone BBT insertion, followed by B-lynch suture (n = 10), uterine artery ascending branch ligation (n = 32), pelvic arterial embolization (n = 21), or cesarean hysterectomy (n = 20). The intraoperative blood loss was 3098 mL (700–18,000 mL) in the balloon failure group and 1120 mL (500–4000 mL) in the balloon success group, respectively (p < 0.01). Multiple logistic regression analysis showed that the number of weeks at pregnancy termination (odds ratio [OR] = 1.188, 95% confidence interval [CI]: 1.023–1.379), the presence of placenta accreta (OR = 2.472, 95% CI: 1.361–4.493), and placenta previa classification (OR = 4.798, 95% CI: 1.328–17.337) were positively associated with BBT failure, while preoperative albumin levels (OR = 0.788, 95% CI: 0.714–0.869) were negatively related to BBT failure. Conclusion: This study suggests that BBT is effective as the second-line treatment for PPH associated with placenta previa in the Chinese population. Placenta accreta and major previa are risk factors for BBT failure. However, our findings need to be confirmed in larger samples with different ethnicities.