Peripartum Uterine Clostridial Myonecrosis: A Report of Two Fatal Cases.
WMJ
; 123(3): 213-217, 2024 Jul.
Article
em En
| MEDLINE
| ID: mdl-39024150
ABSTRACT
INTRODUCTION:
Uterine clostridial myonecrosis is a rare infection associated with a high mortality rate. This report presents 2 cases of maternal mortality resulting from peripartum clostridial myonecrosis of the uterus. CASE PRESENTATION Case 1 is a 30-year-old woman (nullipara) who presented in labor at term with an intra-amniotic infection and fetal demise. She rapidly developed septic shock, and cesarean hysterectomy was performed for a suspected necrotizing uterine infection later identified to be Clostridium septicum. Case 2 is an adolescent who presented in septic shock following first trimester medication abortion and died during emergent exploratory laparotomy; cultures grew Clostridium sordellii. Both patients expired within 18 hours of hospital admission.DISCUSSION:
Given the rapidly progressive course of clostridial infections, maintaining a high index of suspicion is imperative for ensuring timely diagnosis and effective treatment. Prompt recognition of clinical features associated with clostridial myonecrosis - abdominal pain, tachycardia, leukocytosis and hyponatremia - is essential in preventing mortality. The utilization of point-of-care ultrasound may expedite the diagnosis of uterine myonecrosis. When uterine myonecrosis is suspected, immediate initiation of penicillin-based antibiotics, alongside clindamycin, and aggressive surgical intervention including hysterectomy are essential for ensuring survival. Although the decision to perform a hysterectomy can be challenging, especially in cases involving child-bearing-aged patients, it is a vital step to avert a fatal outcome.CONCLUSIONS:
By presenting these cases, we aim to raise awareness of this uncommon, but highly lethal infection to expedite diagnosis and treatment to improve patient outcomes.
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Base de dados:
MEDLINE
Assunto principal:
Infecções por Clostridium
Limite:
Adolescent
/
Adult
/
Female
/
Humans
/
Pregnancy
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article