Acute fetal distress following tooth extraction and abscess drainage in a pregnant patient with maxillofacial infection

Abstract

Oral infections have been implicated in adverse pregnancy outcomes such as pre-eclampsia, premature delivery and growth retardation. A 28-year-old and 9 months pregnant otherwise healthy woman with a complaint of facial swelling and dental pain was referred to the Department of Oral and Maxillofacial Surgery. Oral examination revealed perimandibular and masticator space infection related to the left mandibular third molar tooth. Eight hours after surgical intervention, fetal distress developed. The patient was immediately taken into surgery and a male baby delivered by Caesarean section. The baby was then admitted to the intensive care unit. On the twelfth day of his admission, the baby was discharged in good health. Severe maxillofacial infection in pregnancy is a medically complicated situation which should be treated by an oral and maxillofacial surgeon in consultation with an obstetric and gynaecology service.

Severe Odontogenic Infections during Pregnancy and Related Adverse Outcomes. Case Report and Systematic Literature Review

“…The most frequent odontogenic cause, when specified, was the carious process of the third molar (upper or lower) in 23% of cases, followed by caries of the first molar in 8.7%, and then second molars and premolars, both with 7.3%. Severe odontogenic complications occurred in this study were: cervicofacial cellulitis in 30% of cases [ 3 , 22 ], Ludwig’s angina in 27.5% [ 9 , 14 , 15 , 16 , 18 , 19 , 26 , 27 ], abscesses (submandibular and submental) in 23.2% [ 2 , 12 , 13 , 21 , 27 ], deep neck infection (DNI) in 21.7% [ 7 , 8 , 17 , 23 , 24 , 25 ], mediastinitis in 2.3% [ 7 , 23 ], and brain abscess in one case [ 20 ]. Sixty-nine patients were included; in one case drainage occurred spontaneously, and in two patients, medical therapy was sufficient to solve the clinical condition.…”

“…Before the case presented above, a total of 69 cases had been described in the literature since 1994. A total of 16 case reports [ 7 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] and 5 retrospective studies [ 2 , 3 , 8 , 9 , 27 ] were included in this analysis ( Table 1 and Table 2 ). The mean age of the sample was 27.72 years.…”

“…A patient with a brain abscess underwent a left-sided hemicraniectomy with the evacuation of subdural empyema, and then, due to a worsening of clinical conditions, she was operated five more times [ 20 ]. At last, the patient reported neurological deficits, which included Broca’s aphasia and apraxia associated with the right hemiplegia [ 21 ]. A total of 37.7% of the patients included in the systematic review presented adverse outcomes, which could involve either the fetus or the mother or both.…”

“…A total of 37.7% of the patients included in the systematic review presented adverse outcomes, which could involve either the fetus or the mother or both. Adverse outcomes recorded were: 9 fetal deaths (13%) [ 7 , 8 , 9 , 22 ], 4 babies presented fetal distress (5.8%) [ 12 , 13 , 21 , 23 ], and 2 needed intensive care unit (ICU) (2.9%) [ 19 , 21 ]. Four mothers died (5.8%) [ 8 , 9 ], 6 needed postoperative ICU (8.7%) [ 2 , 14 , 15 , 19 , 24 ], and 3 cases developed sepsis (4.3%) [ 7 , 8 ].…”

“…This data must capture attention and raise awareness of the importance of multidisciplinary treatment of these kinds of patients. Frequently a delay in starting a treatment or an ineffective therapeutic approach have been detected, causing progress of the infectious process [ 15 , 16 , 21 ]. The treatment of the pregnant patient has the potential to affect the lives of two individuals (the mother and the fetus).…”