Postpartum gangrene of three limbs complicating inotrope therapy: A case report

Abstract

BackgroundSymmetrical peripheral gangrene (SPG) is an uncommon but devastating complication in critically ill patients with a high mortality. It is seldom seen in pregnancy and postpartum period.Case presentationWe hereby report a 27-year-old woman diagnosed of having postpartum hemorrhagic shock. The patient developed symmetrical peripheral gangrene triggered possibly by sepsis and inotropes. The patient presented with consciousness disturbance and hemodynamically unstable condition. Owing to the unstable hemodynamic status, inotropic agents with maximum dose of dopamine at 17 mcg/kg/min and norepinephrine of 8 mcg/kg/min were used. On the 4th day of admission, the patient developed gangrene and compartmental syndrome in the limbs. However, even with the dose of inotropic agents tapered, the gangrene did not resolve. So, multiple amputations and fasciotomy were done. Patient also developed acute kidney injury with anuria, thus necessitating hemodialysis treatment.ConclusionAlthough postpartum hemorrhagic shock is of high risk for sepsis and use of inotropes is common, occurrence of peripheral gangrene is rare. A high index of suspicion for the diagnosis and timely intervention will prevent irreparable damage and loss of limb.