Clinical characteristics of 9 septic shock patients during pregnancy
All patients were diagnosed with septic shock in their late pregnancy, with an average age of 26.11±6.9 years, ranging from 18 to 39 years. And the mean gestational age was 33 weeks plus 1 day (Table 1). 78% of patients were from rural area. Two patients were diagnosed as GDM (GDM, gestational diabetes mellitus) and severe preeclampsia during pregnancy respectively. And one patient was complicated with chronic hypertension. Fever was common initial symptom, accompanied by some other symptom, such as lymph node enlargement, gastrointestinal symptom, dyspnea, fatigue and mental symptom. All patients suffered from multiple organ failure. Respiration and circulation were main affected organs (9/9,100%), followed by coagulation (4/9,44.4%), renal function (4/9,44.4%) and liver function (2/9,22.2%). Because of the individual difference, the difference in the period of advanced life support was significant, ranging from 1 to 22 days (Table 1).
The exact location of infection and pathogen was difficult to identify in a short time. More than half of patients (5 in 9 patients) did not be identified the source of infection. The other four patients were respectively infected by Listeria, influenza A virus, Baumanii and Legionella. In
the patients whose pathogen were certain,3/4(75%) had a good prognosis, and only 1/4(25%) progressed rapidly to death, even though the use of ECMO(ECMO, extracorporeal membrane oxygenation )(Table 1).
Pregnancy and fetus outcomes
All patients received advanced life support and were treated with empirical antibiotic until exact pathogenic bacteria was identified. One patient died as soon as admission to hospital due to delayed medical treatments. As shown in Table 2, among the remaining 8 patients, 1 patient continued pregnancy after recovery and the other 7 patients (87.5%) accepted emergency delivery after multidisciplinary discussion. Most of patients underwent cesarean section (5 out of 7 patients, 71.4%, Table 2). After many efforts, 2 women died in childbirth,1 of whom was infected with influenza A virus, and 5 mothers recovered. The total maternal mortality was 33.3% (3 out of 9 patients). Of the 8 patients, 3 patients (37.5%) had IUFD(IUFD, intrauterine fetal death). After emergency delivery, 2 patients recovered and 1 died. Except for 3 cases of IUFD, the rate of live birth was 75% (3 in 4 patients, Table 2), and 1 newborn died from severe asphyxia. The total mortality rate among the 9 patients, including IUFD, was 55.6%.
Maternal and neonatal outcome reported in published literature
As shown in Table3, due to the rare disease, only 15 case reports were retrieved and reviewed. After diagnosed with septic shock, 12 of the 15 patients (80%) received emergency delivery, including 1 patient died shortly and 2 patients were able to continue pregnancy after recovery. The rate of cesarean section was 83.3%. Among 12 patients who chose to deliver, 2 mothers died and 10 mothers recovered after treatment. However, the overall maternal mortality rate was 20%. Most of patients could recover after delivery. The incidence of IUFD was 20%. In 15 patients, the neonatal survival rate was 53.3% (Table 3). Group A streptococcus was considered as the main pathogenic bacteria.