Subject(s)
Delivery Rooms/organization & administration , Delivery, Obstetric/methods , Intensive Care Units, Neonatal/organization & administration , Delivery Rooms/standards , Delivery, Obstetric/standards , Female , Humans , Infant, Premature , Intensive Care Units, Neonatal/standards , Neonatology , Practice Guidelines as Topic , Respiration, Artificial/methods , Umbilical Cord/physiology , United KingdomABSTRACT
A 31-year-old G3P2002 with history of two prior caesarean sections presented with influenza-like illness, requiring intubation secondary to acute respiratory distress syndrome. Investigations revealed intrauterine fetal demise at 30-week gestation.She soon deteriorated with sepsis and multiple organs impacted. Risks of the gravid uterus impairing cardiopulmonary function appeared greater than risks of delivery, including that of uterine rupture. Vaginal birth after caesarean was achieved with misoprostol and critical care status rapidly improved.Current guidelines for management of fetal demise in patients with prior hysterotomies are mixed: although the American College of Obstetricians and Gynecologists recommends standard obstetric protocols rather than misoprostol administration for labour augmentation, there is limited published data citing severe maternal morbidity associated with misoprostol use. This case report argues misoprostol-augmented induction of labour can be a reasonable option in a medically complex patient with fetal demise and prior hysterotomies.
Subject(s)
Fetal Death/etiology , Labor, Induced/methods , Labor, Obstetric/drug effects , Misoprostol/administration & dosage , Oxytocics/administration & dosage , Administration, Intravaginal , Adult , Delivery, Obstetric/standards , Female , Humans , Hysterotomy/adverse effects , Intubation, Intratracheal/methods , Misoprostol/pharmacology , Multiple Organ Failure/etiology , Oxytocics/pharmacology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Trimester, Third , Respiratory Distress Syndrome/complications , Respiratory Distress Syndrome/therapy , Treatment Outcome , Uterine Rupture/prevention & controlABSTRACT
BACKGROUND: Since the first report of the new coronavirus (COVID-19) infection in December of 2019, it has become rapidly prevalent and been declared as a Public Health Emergency of International Concern by the World Health Organization. There are quite a few cases reported involving delivery with COVID-19 infection, but little valuable suggestion was provided about what healthcare providers of obstetrics and neonatology should do in their clinic practice for unknown status or presumed negative women. Here, we summarized the current practice of delivery management in China that successfully prevented rapid increase in adverse pregnancy outcomes and nosocomial infection in departments of obstetrics and neonatology during the pandemic of COVID-19.