CASE REPORT Postpartum fever and shortness of breath

Morton, Adam (2013) CASE REPORT Postpartum fever and shortness of breath. BMJ, 346 7896: . doi:10.1136/bmj.f391

Author Morton, Adam
Title CASE REPORT Postpartum fever and shortness of breath
Journal name BMJ
ISSN 1756-1833
Publication date 2013-01
Year available 2013
Sub-type Editorial
DOI 10.1136/bmj.f391
Open Access Status DOI
Volume 346
Issue 7896
Total pages 4
Place of publication London, United Kingdom
Publisher B M J Group
Language eng
Formatted abstract
A 26 year old gravida 3 para 2 woman developed fever and malaise after an uncomplicated spontaneous vaginal delivery at 38 weeks’ gestation. Postpartum vaginal loss was unremarkable. Her baby, a boy with a birth weight of 3420 g, was well. Her symptoms were initially attributed to a viral illness. However, she gradually became more unwell over the next two days with lightheadedness, abdominal pain, fever, and shortness of breath, and she was noted to have tachycardia and hypotension. On the third day postpartum, while still an inpatient, she was extremely unwell. Pulse rate was 140 beats/min, blood pressure was 80/20 mm Hg, and oxygen saturations were 91% while breathing oxygen at 6 L/min. Heart sounds were dual, chest examination showed bibasal crackles, and she had hypogastric tenderness. Initial investigations were haemoglobin 96 g/L (pregnancy specific reference range 115-165), white blood cell count 11.2×109/L (4-15), platelets 155×109/L (150-400), prothrombin time 21 s (11-16), activated partial thromboplastin time 52.7 s (23-38), fibrinogen 13.2 µmol/L (5.1-11.8; 1µmol/L=3401 mg/dL), creatinine 136 µmol/L (1 µmol/L=0.01 mg/dL;30-70), estimated glomerular filtration rate 41 mL/min (80-120), serum bicarbonate 10 mmol/L (1 mmol/L=1 mEq/L; 22-33), and venous lactate 6.6 mmol/L (1 mmol/L=9.01 mg/dL; 0.5-2.2).

She was given intravenous antibiotics and hydrocortisone and transferred to the intensive care unit (ICU). Chest radiography showed diffuse bilateral lower zone infiltrates. A non-contrast computed tomogram of the abdomen and pelvis was unremarkable. Echocardiography showed bilateral reduction in left and right ventricular function, with a left ventricular ejection fraction (LVEF) of 40% and no evidence of endocarditis. Cardiac troponin I was raised at 0.34 µg/L (<0.05), with a subsequent peak value of 22 µg/L.
Keyword Peripartum Cardiomyopathy
Myocardial Dysfunction
Subsequent Pregnancy
Q-Index Code CX
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Editorial
Collection: School of Medicine Publications
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Created: Mon, 02 Sep 2013, 16:29:50 EST by System User on behalf of School of Medicine