RESUMO
The current case highlights the management of abruptio placentae in pregnant women with an O Rhesus (Rh)-negative blood group with multiple alloantibodies. We describe a unique case of chronic placental separation in a young primigravida presenting with intrauterine hematoma and intrauterine fetal death (IUFD), who had an O Rhesus-negative blood group with alloimmunization against D, C, and S antigens. The implications in management were the dilemma in diagnosis, the ABO blood grouping discrepancy, multiple alloantibodies including Rh alloimmunization, chronic placental abruption with postpartum hemorrhage, and scope for further pregnancies. Chronic placental separation or abruption can occur silently in some cases. On presentation, they may be mistaken with or for other lesions. In Rh-negative pregnancies, chronic abruption can lead to alloimmunization against Rh and other clinically significant antigens as well. Women with suspicion for chronic abruption must undergo detailed blood group testing as well as immunohematological workup at a nearby transfusion medicine department with a facility for complex immunohematological resolutions.
RESUMO
OBJECTIVES: Maternal sepsis is a life-threatening condition. Biomarkers have been found to be useful in early detection of sepsis in the critical care setting. We aimed to determine the diagnostic performance of different biomarkers such as procalcitonin, C-reactive protein (CRP), absolute eosinophil count, and activated partial thromboplastin time (aPTT) in maternal sepsis. METHODS: A total of 35 patients were enrolled in this prospective observational study. Patients with suspected sepsis were evaluated for multi-organ dysfunction. The blood samples for testing of these biomarker levels were obtained at the time of enrollment in the study (day 1), and on day 3 and day 7. Trends of each marker were followed and correlated with the clinical picture. RESULTS: Of 35 enrolled patients, 30 completed the study. Among these, 18 had sepsis and 12 were designated as without sepsis. Sensitivities of procalcitonin, CRP, aPTT, and absolute eosinophil count were 83.33%, 77.78%, 55.56%, and 58.82% whereas their specificities were 66.67%, 75.0%, 100%, and 75%, respectively. Area under the curve was highest for procalcitonin (0.813) followed in decreasing order by CRP (0.778), aPTT (0.731), and eosinophil count (0.642), respectively. CONCLUSION: Procalcitonin and CRP may be used as a valuable adjunct in the clinical stepwise approach for the prompt diagnosis of maternal sepsis.
