Case 1
A 26-year-old gravida 1, para0 at 20+ 3/7gestational weeks presented for amniocentesis to determine whether her foetus was affected by sex chromosomal aneuploidy due to the non-invasive DNA test results. Her past medical history was unremarkable, with no smoking or alcohol exposure. Prior to amniocentesis, her temperature, routine blood count, CRP and ultrasound were all normal. Genetic amniocentesis was performed under sterile conditions and without difficulty at 3P.M. A 22-gauge needle was passed into the right lower quadrant of her uterus, and 30 mL of clear fluid was extracted during the first attempt. The foetal heart rate after the procedure was within the normal range. Afterwards, the patient complained of nausea, vomiting, and back pain and then developed a fever of up to 40°C at home 35 hours after amniocentesis. Then, she came to the ER, and foetal demise was observed, along with abnormal blood tests.
On admission, her vital signs in our hospital were as follows: temperature,40°C; pulse, 100, respiratory rate, 24; blood pressure, 83/55 mmHg; severe inflammatory reaction(WBC: 26.4×10^9/L, platelet count:58×10^9/L,CRP:89.4 mg/L, PCT: >100.000 ng/ml); Scr, 150 µmol/L; D-dimer, 64,050 µg/L FEU; 3P test,negative; and BNP,6236 pg/ml. The patient still complained of chills, vaginal spotting, and irregular contraction. The blood pressure was 65–80/45–55 mmHg with a drop in noradrenaline (3 ml/h) and hydrocortisone (200 mg, ivggt). Forty hours after amniocentesis, she spontaneously delivered an intact, macerated-appearing foetus that was foul-smelling and purulent (500 g). The foul-smelling placenta (150 g) was evacuated using suction and sharp curettage under ultrasound guidance. The bleeding was 100 ml. The patient required further blood pressure support with IV phenylephrine during and after D&C, and she was transferred to the surgical intensive care unit (ICU) for further stabilisation and treatment after the procedure. She remained in the ICU overnight while receiving IV pressers and fluids. Colloid infusion was considered in the postoperative period; Tylenol and ornidazole were continued for the remainder of her hospital course. The patient showed gradual improvement, and her blood cultures, discharge cultures and some tissue from the foetus all revealed Escherichia coli. She was discharged home on hospital day 10 with a plan to continue amoxicillin clavulanate for 14 days per the recommendation of infectious disease specialists.
Case 2
A 19-year-old gravida 1, para0 at 31+ 5/7gestational weeks requested induction because the result from amniocentesis was chromosomal aneuploidy. Her past medical history was unremarkable, with no smoking or alcohol exposure. Prior to amniocentesis, her temperature, routine blood count, CRP and ultrasound were all normal. Genetic amniocentesis and injection of potassium chloride into the foetal heart were performed under sterile conditions and without difficulty at 4 P.M. A 22-gauge needle was passed into the right lower quadrant of her uterus, and 30 mL of clear fluid was extracted with the first attempt. The foetal heart rate after the procedure was demise. The patient complained of nausea, vomiting, abdominal pain and then fever of up to 38°C in the hospital 18 hours after amniocentesis. Twenty-eight hours after amniocentesis, she spontaneously delivered an intact, macerated-appearing foetus that was foul-smelling and purulent (1500 g) and a foul-smelling placenta. Her vital signs were as follows: temperature, 38.3°C; pulse, 125–130 bpm, respiratory rate, 24 bpm; blood pressure,75/33 mmHg; severe inflammatory reaction(WBC: 15.0×10^9/L, platelet count: 76×10^9/L,CRP: 63.9 mg/L, PCT: >100.000 ng/ml); D-dimer, 10,941 µg/L FEU, 3P test, negative; and BNP,2397 pg/ml. The patient continued to complain of abdominal pain and vomiting. The blood pressure was 60–80/18–55 mmHg with a drop in noradrenaline (3 ml/h) and hydrocortisone (200 mg, ivggt). She remained in the ICU overnight while receiving IV pressers and fluids. Colloid infusion and blood transfusion were considered in the postoperative period; Tylenol and ornidazole were continued for the remainder of her hospital course. The patient showed gradual improvement, and her blood cultures, discharge cultures and some tissue from the foetus all revealed Klebsiella pneumoniae. She was discharged home on hospital day 10 with a plan to continue amoxicillin clavulanate for 14 days per the recommendation of infectious disease specialists.