Septic Shock, Adult Respiratory Distress Syndrome, and Disseminated Intravascular Coagulopathy Following Midtrimester Genetic Amniocentesis

J R Johnson,M A Hamid,J Kasznica,P G Stubblefield

doi:10.1155/s1064744997000707

Abstract

Background: Midtrimester genetic amniocentesis is a commonly performed procedure, with acknowledgment of some risk to mother and fetus. Case: We present an unusual case of midtrimester genetic amniocentesis with bowel injury and resulting septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulation. A total abdominal hysterectomy and bilateral salpingoophorectomy were required for resolution of sepsis. The patient also required prolonged ventilatory support postoperatively. Conclusion: Although relatively safe, genetic amniocentesis can result in serious morbidity, and attention to technique should be maintained.

Highlights

Case: We present an unusual case of midtrimester genetic amniocentesis with bowel injury and resulting septic shock, adult respiratory distress syndrome, and disseminated intravascular coagulation
Conclusion: relatively safe, genetic amniocentesis can result in serious morbidity, and attention to technique should be maintained
We describe an unusual case of severe sepsis with long-term morbidity following genetic amniocentesis

Summary

Conclusion

Genetic amniocentesis can result in serious morbidity, and attention to technique should be maintained. Upon arrival at the tertiary facility, it was determined that the patient had blood gases of pH 7.33, a pCOz of mmHg, a pOe of mmHg, and percent Oz saturation of 91.7% while receiving 100% oxygen Her blood pressure was 90/40 mmHg, and her pulse was in the 140-bpm-range. A positive end expiratory pressure of 15 mmHg and FiOz of 70-80% were needed, and the patient remained febrile at 38.8C Her heart rate remained [130-150] bpm, and infusions of dopamine, neosynephrine, and dobutamine were needed to maintain the blood pressure at 75-110/ 40-70 mmHg. Cardiac output was low at 5.5 to 7 1/min, and pulmonary capillary wedge pressure was [17-20] mmHg. Echocardiography revealed hypokinetic ventricles.

Findings

DISCUSSION

Simpson JL