Poster Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Pseudomonas Aeruginosa Sepsis secondary to Cervical Cerclage (#148)

Michelle Yu 1 , Steven Joung 1
  1. Nepean Hospital, Kingswood, NSW, Australia

Introduction

Pseudomonas aeruginosa (PA) is reported in literature as the most common gram-negative bacteria associated with severe hospital acquired infections particularly in the intensive care setting­1. The incidence of PA sepsis in feto-maternal cases is less characterised in literature but clinically important being linked to early onset neonatal sepsis. Furthermore significant contributory factors to obstetric septic shock are cervical cerclage and fetal death in utero (FDIU). Thus there are several obstetric medicine considerations to be balanced in management of cervical shortening.

Case Report

We present the case of a 26 year old singular parity with previous preterm normal vaginal delivery at 35 weeks gestation. Morphology scan in the current pregnancy showed bulging membranes. She had a transvaginal rescue cervical cerclage inserted. She presented 10 days later at 20 weeks gestation with abdominal pain, urge to push and febrile. The peripheral hospital team were unable to remove the cervical cerclage due to difficult speculum examination. She was transferred to a tertiary centre with FDIU and early features of chorioamnionitis. Two hours after transfer stillborn infant delivered vaginally through the cervical cerclage. Maternal clinical deterioration occurred soon after and she was transferred to ICU requiring ionotropic support. In consultation with infectious disease and obstetric medicine teams she was treated for septic shower. She improved after 7 day course of cefepime and metronidazole and counseled for subsequent pregnancies.

Discussion

In pregnancies with cervical incompetence there is inconclusive evidence in literature for cerclage compared to conservative management. 2,3 Cerclage is associated with potential severe fetomaternal consequences including sepsis. Risk factors for PA sepsis have been suggested to include prior treatment with antibiotics, in particular broad-spectrum and prolonged hospitalization. 1 There are varying post-cerclage management practices including both the aforementioned factors. Early recognition of sepsis and close obstetric care post cerclage is essential.

  1. El Amari, E. B., E. Chamot, R. Auckenthaler, J. C. Pechere, and C. van Delden. 2001. Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates. Clin. Infect. Dis. 33:1859-1864.
  2. Daskalakis G, Papantoniou N, Mesogitis S et al. Management of cervical insufficiency and bulging fetal membranes. Obstet. Gynecol 2006; 107: 221–226.
  3. Althuisius, S.M., Dekker, G.A., Hummel, P., and van Geijn, H.P. Cervical incompetence prevention randomized cerclage t. cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol. 2003; 189: 907–910