Another Fatality Due to Postpartum Group A Streptococcal Endometritis in the Modern Era

Singhal, Akhil; Alomari, Mohammad; Gupta, Surendra Kumar; Almomani, Shaden; Khazaaleh, Shrouq

doi:10.7759/cureus.4618

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…The patient is likely to spike a high fever 2 to 3 days postpartum 7 . Also present may be nonspecific signs such as nausea, vomiting, headaches, chills, and abdominal pain 8 . Despite appropriate measures and aggressive interventions, complications still arise.…”

Section: Discussionmentioning

confidence: 99%

Acute Endometritis-Myometritis

Corn,

Kemp

2023

Am J Forensic Med Pathol

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A middle-aged female patient was admitted to the hospital for delivery of a 27-week estimated gestational age fetus. The fetus was live born and with no acute complications other than being born prematurely. One day later, she developed left-sided facial droop associated with hypertension, tachycardia, chills, cramping, and lower extremity edema. Laboratory testing revealed an elevated white blood cell count, elevated serum urea nitrogen and creatinine levels, and hypoglycemia. The patient was transferred to the intensive care unit but died soon after. As the cause of death was unknown, an autopsy was performed.Even given the short interval between time of death and autopsy and in the background of refrigeration, the body had early decomposition. By internal examination, the uterus was enlarged and diffusely dark red discolored (Figs. 1, 2). Microscopic examination revealed numerous aggregates of bacterial cocci throughout the myometrium, numerous large aggregates of inflammatory cells, which often included apparent immature granulocytes (irregular, slightly lobulated nuclei with a distinct rim of cytoplasm), and numerous eosinophils. Large clusters of more characteristic neutrophils were also identified (Figs. 3,4). Associated with the inflammatory infiltrates was cellular debris. In patches, the myometrium appeared necrotic, with no nuclei visible and with rounded cellular outlines and/or ragged cytoplasm, which was slightly more eosinophilic than expected; however, postmortem change impaired the interpretation. There was no evidence at autopsy of a stroke.

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Section: Discussionmentioning

confidence: 99%

Acute Endometritis-Myometritis

Corn,

Kemp

2023

Am J Forensic Med Pathol

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“…Peripartum group A streptococcus (GAS) sepsis is a rare yet highly morbid cause of puerperal sepsis that poses significant challenges in diagnosis and management [1][2][3]. Despite clinical advances, systemic consequences of invasive GAS infections have a propensity to escalate rapidly, affecting multiple organ systems and leading to severe morbidity and mortality [4][5][6]. This is especially true in the peripartum population, with postpartum women carrying upwards of 20 times the risk of their non-pregnant counterparts [7].…”

Section: Introductionmentioning

confidence: 99%

“…Despite its infrequency, familiarity with manifestations of GAS infections is necessary for prompt diagnosis and employment of treatment strategies. This involves comprehensive measures such as blood and urine cultures, evaluation of lactic acid, endometrial sampling for culture, early administration of broad-spectrum antibiotics, and low threshold for surgical intervention [5]. Once GAS infection has been confirmed, targeted antibiotic therapy with high-dose penicillin and clindamycin is recommended [3,5].…”

Section: Introductionmentioning

confidence: 99%

Surviving Postpartum Group A Streptococcus Sepsis Complicated by Multiorgan System Failure: A Complex Case Presentation

Saab,

Assali,

Angelides

et al. 2024

Cureus

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Postpartum group A streptococcal (GAS) sepsis is a rare obstetric complication with severe clinical implications and high morbidity and mortality, presenting diagnostic and management challenges. This report analyzes a complex case of postpartum GAS sepsis, highlighting the importance of understanding the pathophysiology and clinical trajectories of this often fatal pathogen. A comprehensive analysis was conducted on a patient with postpartum GAS sepsis. Literature review and case comparisons informed the study's context. Medical history, clinical presentation, diagnostic procedures, interventions, and outcomes were reviewed and documented. The patient presented on postpartum day 5 with abdominal pain and vaginal bleeding. Her condition rapidly deteriorated, requiring aggressive interventions and systemic support. Blood cultures confirmed GAS bacteremia. She developed toxic shock syndrome, cardiomyopathy with acute cardiac failure, and seizures secondary to subdural empyema. Multidisciplinary care facilitated eventual clinical recovery. Obstacles in achieving treatment balance were evident, underscoring the systemic nature of GAS infection and the significance of interdisciplinary collaboration. This case underscores the complex pathophysiology of postpartum GAS sepsis and the importance of prompt treatment initiation, aggressive intervention, and a multidisciplinary approach to management. The study contributes to the understanding of disease progression and clinical management in severe peripartum infections, reaffirming the need for further research to improve outcomes.

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Necrotizing fasciitis as a rare form of postpartum sepsis. Case report

Belokrinitskaya,

Golygin,

Fomin

et al. 2024

Gynecology

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Modern strategies of the World Health Organization and clinical guidelines of the world's leading professional communities of obstetricians and gynecologists, based on effective clinical practices, make it possible to attribute sepsis to potentially preventable causes of direct maternal mortality with the possibility of a near-miss situation outcome. Necrotizing fasciitis (NF) is a disseminated soft tissue infection that is a rare and life-threatening form of septic complications in obstetrics. The disease is little known to practical doctors, and its outcome largely depends on the timely diagnosis and early initiation of adequate treatment, including massive antibiotic therapy and urgent surgical removal of necrotic tissue with correction of multiple organ disorders. Pregnant women and women in labor are at risk for NF since its main risk factors are mucosal and skin injuries of any origin, immunosuppression, diabetes, and obesity. We present two cases of near miss due to the NF and sepsis after vaginal birth and cesarean section. At the manifestation of the disease, both patients started broad-spectrum antibiotic therapy. When soft tissue necrosis appeared, debridement was performed. A 31-year-old patient had a more severe course of the disease (septic shock, severe multiple organ failure) and a less favorable outcome (hysterectomy, panhypopituitarism, large ventral hernia), which is probably due to the presence of significant risk factors (history of sepsis, grade 1 obesity, autoimmune thyroiditis). In a 37-year-old somatically healthy patient with only one risk factor (age over 35 years), NF's clinical course and outcome after cesarean section were more favorable (the uterus was preserved, and the hormonal and metabolic status was not disturbed). Pregnant women and women in labor should be identified as a risk group for NF due to unavoidable damage of the mucous membranes and skin even during normal childbirth and routine obstetric procedures, a high rate of surgical delivery, physiological immunosuppression, and a high prevalence of obesity and diabetes. Rapidly initiated complex treatment, including massive antibiotic therapy, debridement, immunoglobulins, efferent therapies, and hyperbaric oxygenation, can improve the outcome of the disease and prevent maternal mortality.

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Another Fatality Due to Postpartum Group A Streptococcal Endometritis in the Modern Era

Cited by 3 publications

References 14 publications

Acute Endometritis-Myometritis

Acute Endometritis-Myometritis

Surviving Postpartum Group A Streptococcus Sepsis Complicated by Multiorgan System Failure: A Complex Case Presentation

Necrotizing fasciitis as a rare form of postpartum sepsis. Case report

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