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Canadian Journal of Anesthesia, Vol 42, 330-334, Copyright © 1995 by Canadian Anesthesiologists' Society

ARTICLES

Maternal death following epidural anaesthesia for caesarean section delivery in a patient with unsuspected sepsis

PJ Morgan
Department of Anaesthesia, Mount Sinai Hospital, Toronto, Ontario.

Sepsis in the parturient may be difficult to recognize in light of the physiological changes associated with pregnancy. The purposes of this report are to highlight the signs and symptoms which indicate an underlying septic process and the management of these patients in the peripartum period. This 32-yr-old GII PI woman with twin gestation presented at 36 wk in labour. Her temperature was 35.3 degrees C, she was normotensive and had a normal white blood cell count. After epidural anaesthesia was administered for Caesarean section, she became apnoeic, pulseless and unresponsive. Despite aggressive cardiopulmonary resuscitation, neither she nor her twin babies survived. Post mortem blood work revealed a considerable left shift of her white blood count (> 60% bands) and an anion gap acidosis. Autopsy revealed evidence of widespread Group A beta-haemolytic streptococcal sepsis. Diagnosis of sepsis in the parturient involves assessment of the patient's temperature, WBC and differential and acid-base status. Evaluation of the intravascular volume must precede anaesthetic intervention. Epidural anaesthesia may be considered in the labouring and Caesarean section patient who has been fluid-resuscitated. Emergency operative delivery may result in cardiovascular compromise in the patient with severe sepsis.


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 Obstet GynecolHome page
H. Udagawa, Y. Oshio, and Y. Shimizu
SERIOUS GROUP A STREPTOCOCCAL INFECTION AROUND DELIVERY
Obstet. Gynecol., July 1, 1999; 94(1): 153 - 157.
[Abstract] [Full Text] [PDF]


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Copyright © 1995 by the Canadian Anesthesiologists' Society.