SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Chorioamnionitis results from bacteria present in the uterus at conception or that ascend from the vagina during pregnancy. It may be subgrouped into clinical/overt, subclinical infection, or histologic chorioamnionitis. The incidence of ARDS in pregnancy is about 16-70 patients per 100000 with mortality rates ranging from 11% to 50%. The causes of ARDS may be associated with both obstetric and non-obstetric etiologies. Extracorporeal membrane oxygenation (ECMO) is increasingly used for the management of severe ARDS and in many cases, serves as a last resort in severely ill patients. We report on the successful use of ECMO in a postpartum patient with ARDS secondary to Chorioamnionitis CASE PRESENTATION: 24yr-old gravida 1, para1, admitted at 37-weeks for induction of labour for uncontrolled gestational hypertension. She underwent cesarean section (CS) after failed induction but developed intermittent fever, chills, productive cough and progressively worsening shortness of breath. Computed tomography angiography was negative for pulmonary embolism but showed bilateral lung infiltrates. CT abdomen showed no evidence of abscess/occult infection. She was started on antibiotics due to high suspicion for pneumonia and chorioamnionitis and pressors for septic shock. Urine and uterine swab cultures grew E. Coli. Four days after CS, she went into acute hypoxic respiratory failure and was intubated. She developed ARDS with worsening hypoxia and escalating ventilator requirements necessitating cannulation for Veno-venous ECMO. Her placenta showed chorioamnionitis on pathology and she had exploratory laparotomy and hysterectomy for source control. Patient markedly improved on ECMO with near resolution of ARDS, she was subsequently decanulated and extubated after 4 days on ECMO DISCUSSION: Respiratory failure in the post-partum period may be related to pregnancy-specific conditions or other respiratory diseases. Management requires a multidisciplinary approach. Therapy for patients with ARDS is supportive, aimed at improving gas exchange and preventing complications (Low tidal volume, high Positive end-expiratory pressure ventilation strategies). Treatment of the underlying condition is key in determining survival. Despite extensive clinical research to improve the management of ARDS, mortality remains high, few strategies have shown a mortality benefit. However, survival from ARDS in this patient population appears to be as good as, if not better than that in the general population, likely because of they tend to be young and healthy CONCLUSIONS: Chorioamnionitis should be suspected in all post-partum patients who develop unexplained ARDS. ECMO often represents the last resort for severe ARDS. There is very limited literature on the use of ECMO in the management of post-partum ARDS. To the best of our knowledge, this is the first case report connecting Chorioamnionitis induced ARDS needing ECMO Reference #1: Weyrich, J., Bogdanski, R., Ortiz, J., Kuschel, B., Schneider, K., & Lobmaier, S. (2016). Interdisciplinary Peripartum Management of Acute Respiratory Distress Syndrome with Extracorporeal Membrane Oxygenation – a Case Report and Literature Review. Geburtshilfe Und Frauenheilkunde, 76(03), 273-276. https://doi.org/10.1055/s-0041-110132 Reference #2: Carmona, F., Fábregues, F., Alvarez, R., Vila, J., & Cararach, V. (1992). A rare case of chorioamnionitis by Morganella morganii complicated by septicemia and adult respiratory distress syndrome. European Journal Of Obstetrics & Gynecology And Reproductive Biology, 45(1), 67-70. https://doi.org/10.1016/0028-2243(9290196-6) Reference #3: Juneja, S., Tandon, P., Gupta, V., Wander, G., Mahajan, R., & Singh, A. et al. (2018). ECMO: a lifesaving modality in ARDS during puerperium. International Journal Of Reproduction, Contraception, Obstetrics And Gynecology, 7(10), 4285. https://doi.org/10.18203/2320-1770.ijrcog20184168 DISCLOSURES: No relevant relationships by Saed Awadallah, source=Web Response No relevant relationships by Afua Kunadu, source=Web Response No relevant relationships by Ogugua Obi, source=Web Response