Staphylococcal septicemia and adult respiratory distress syndrome in pregnancy treated with extracorporeal carbon dioxide removal.

BACKGROUND: Septicemia in pregnancy may take an especially fulminant course. Adult respiratory distress syndrome (RDS) and disseminated intravascular coagulation (DIC) are associated life-threatening complications. Treatment consists of appropriate antibiotic coverage and supportive measures. CASE: A previously healthy 21-year-old woman presented at 26 weeks' gestation with staphylococcal sepsis of undetermined origin. Her course was complicated by the rapid onset of adult RDS, DIC, and multi-organ-system failure, resulting in preterm delivery. Despite maximal ventilatory support, her pulmonary status continued to deteriorate. She was treated ultimately with extracorporeal carbon dioxide removal and survived without serious sequelae. CONCLUSION: Extracorporeal carbon dioxide removal may improve survival in gravidas with adult RDS by decreasing the required airway pressures for ventilation, thus permitting pulmonary recovery.

Gestational diabetes mellitus: antenatal variables as predictors of postpartum glucose intolerance.

OBJECTIVE: To determine whether antepartum variables can predict postpartum glucose intolerance. METHODS: Glucose tolerance was assessed 6 weeks postpartum in 94 of 238 women with gestational diabetes using a 2-hour, 75-g oral glucose tolerance test (GTT). Selected antepartum variables were analyzed for predictive ability for postpartum glucose intolerance. RESULTS: Of 238 patients, 94 (39%) returned for a GTT. Those returning and those not returning were similar in all variables. Postpartum glucose intolerance occurred in 34%: impaired glucose tolerance in 18%, overt diabetes in 16%. No single maternal, intrapartum, or neonatal variable was predictive of postpartum glucose intolerance in all cases. Predictive variables included: requirement for insulin (insulin versus diet: 25 versus 3% impaired glucose tolerance, 26 versus 0% diabetes; P = .001), poor glycemic control (any 2-hour postprandial blood sugar level of 150 mg/dL or higher: 34 versus 5% diabetes; P = .005), and the 50-g GTT value (200 mg/dL or higher: 32 versus 6% diabetes; P = .01). For insulin requirement, the relative risk (RR) was 17.28 (95% confidence interval [CI] 2.46-121.45), and for the above three variables combined, the RR was 19.68 (95% CI 2.88-134.2). When the insulin dose was at least 100 U/day, all patients had abnormal glucose tolerance postpartum (RR = 34.00, 95% CI 4.93-234.39). CONCLUSIONS: Postpartum glucose screening is not warranted for women at low risk who do not require insulin during pregnancy. The incidence of postpartum glucose intolerance in this group is very low. Women with risk factors should receive postpartum screening. Patients receiving at least 100 U/day of insulin have a 100% incidence of postpartum glucose intolerance.