Treatment Challenges in a Pregnant Patient With Severe Burn Injury and Wound Care Using Amniotic Membrane: A Case Report.

ABSTRACT

We report a case of severe burn injury in a 42-year-old pregnant patient referred to our hospital's burn unit after experiencing a scald burn injury that burned her neck, chest, trunk, abdomen and limbs. The patient had burn wounds distributed on her neck, all four extremities, the chest and abdomen, with a total burn area of 46.5%. The burn wounds were treated with surgical debridement and then covered with silver sulfadiazine and damp gauze. The patient's wounds were treated every three days. The patient delivered a healthy baby full-term through a spontaneous, vaginal delivery. After delivery, the amniotic membrane from the patient was used as an amniotic membrane graft and was planted on the patient's chest, right arm and right thigh. The amniotic membrane in this patient helped to accelerate the preparation of the wound bed for skin grafting. Split-thickness skin grafts were then used on the wounds and the patient was discharged from the hospital one week later. Patients that present with burn injuries during pregnancy require intense monitoring and careful management from a multidisciplinary team. A collaborative effort needs to be made in order to plan the best outcome for the mother and fetus. Precise and early resuscitation is the first step to treating such cases. The administration of fluids should be titered based on the patient's hemodynamic condition and urine output. Wound management can also be optimized using the amniotic membrane as a temporary dressing before skin grafting.

Nous rapportons le cas d'une femme de 42 ans, enceinte, hospitalisée dans le service après un ébouillantement touchant le cou, le thorax, l'abdomen et les membres, représentant 46,5% SCT. Les pansements étaient réalisés tous les 3 jours avec de la sulfadiazine argentique recouverte de gaze humide. La patiente a accouché naturellement, à terme. Sa membrane amniotique a été utilisée pour recouvrir le thorax et les membres droits en attente de greffes, la patiente étant sortie 1 semaine après leur réalisation. Les patientes se brûlant durant leur grossesse doivent bénéficier d'un suivi multidisciplinaire attentif s'intéressant à la maman et au fœtus. Le remplissage initial doit être adapté à l'hémodynamique et à la diurèse. Le traitement local peut être optimisé, avant greffe, par l'utilisation de la membrane amniotique.