Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission.

BACKGROUND: Previous studies on severe maternal sepsis during pregnancy or the postpartum period are rare and have focused on septic abortion. Voluntary abortion was legalized in France in 1975. This study was conducted to reassess the characteristics of maternal sepsis that have been managed in a French intensive care unit. METHODS: A retrospective study of 66 women admitted to an intensive care unit for sepsis from 1977-2008 was performed. Data on sources of infection, microbial agents and maternal and fetal outcomes were collected. Data from 1977-1992 and 1993-2008 were compared. RESULTS: Over time, the rate of intensive care admission for maternal sepsis did not change (0.75 episodes per 1000 deliveries in 1977-1992 versus 0.72/1000 in 1993-2008, P=1.0). The percentage of septic abortions decreased from 14% to 0%, whereas that of antepartum infections increased from 50% to 79% (P<0.01). The percentage of non-bacterial infections increased from 0% to 19% (P=0.04), and the percentage of pelvic infections had a tendency to decrease from 54% to 27% (P=0.06). Pelvic infections were due to enterobacteriaceae (50%), gram-positive cocci (45%), and/or anaerobes (23%). Maternal and fetal mortality rates were 6% and 33%, respectively. CONCLUSIONS: Over time, our intensive care unit has seen fewer cases of septic abortion. However, maternal sepsis remained a cause of intensive care admission and both maternal and fetal death. The percentages of antepartum and non-bacterial infections have increased over time. A prospective multicentre study is required to confirm these results and to investigate questions such as the effect of maternal sepsis on long-term fetal outcome.

[Fatal acute encephalopathy due to 5-fluorouracil treatment]. / Encéphalopathie aiguë fatale secondaire à un traitement par 5-fluoro-uracile.

INTRODUCTION: Encephalopathies from 5 fluorouracil (5FU) are rare and generally resolve favorably. CASE: Six days after her first course of chemotherapy combining 5FU and cisplatin, a 45-year-old woman developed acute encephalopathy with altered consciousness and convulsions. MRI showed hyperintense signals of the white matter, mainly ventricular. Despite symptomatic treatment and thiamine perfusion in intensive care, the patient deteriorated and resuscitation failed. Blood tests confirmed 5FU toxicity. DISCUSSION: 5FU encephalopathies are rare and most often resolve favorably after treatment is stopped. Two pathophysiologic mechanisms may explain these encephalopathies: a deficit of dihydropyridine dehydrogenase, leading to an increased level of serum uracil with digestive and mucosal toxicity, or interaction of 5FU catabolites with various intracerebral metabolic pathways.