Use of recombinant human activated protein C in treatment of severe sepsis in a pregnant patient with fully symptomatic ovarian hyperstimulation syndrome
Małgorzata Mikaszewska-Sokolewicz, Ewa Mayzner-Zawadzka
Med Sci Monit 2005; 11(6): CS27-32
Background: Severe sepsis during pregnancy is a life-threatening condition for the mother, due to multiorgan failure and uncontrolled infl ammatory response. It is associated with high risk of death for the fetus.
Case Report: The paper presents the course and treatment of severe iatrogenic sepsis in a patient in very early pregnancy. The sepsis was a result of complications after overstimulation of the ovaries in the
course of treatment of infertility. The risk of the patient’s death, assessed in the Intensive Care Unit according to APACHE II and SAPS II scores was 73%, whereas indirect assessment of the embryo
in the 3[sup]rd[/sup] week of pregnancy, based on determination of serum gestational hormone levels was ambiguous, but rather unfavorable. The patient’s condition improved considerably after intensive treatment, including, among others, the use of activated protein C (APC). After the completion of treatment, in the 5[sup]th[/sup] week of pregnancy, the gestational hormone levels increased to the values appropriate for such fetal age. The development of pregnancy was also confi rmed by ultrasonography.
Conclusions: The paper presents a case of severe sepsis in the course of ovarian hyperstimulation syndrome, not described in the literature so far, as well as the fi rst successful administration of activated protein C in 21-day pregnancy.
Keywords: Ovarian Hyperstimulation Syndrome - drug therapy, Ovarian Hyperstimulation Syndrome - physiopathology, Pregnancy Complications, Infectious - drug therapy, Pregnancy Complications, Infectious - physiopathology, APACHE, Adult, Cardiac Output, Heart Rate, Ovarian Hyperstimulation Syndrome - physiopathology, Platelet Count, Pregnancy, Pregnancy Complications, Infectious - physiopathology, Protein C - therapeutic use, Recombinant Proteins - therapeutic use, Sepsis - etiology, Stroke Volume