Use of recombinant human activated protein C in treatment of severe sepsis in a pregnant patient with fully symptomatic ovarian hyperstimulation syndrome.
BACKGROUND
Severe sepsis during pregnancy is a life-threatening condition for the mother, due to multiorgan failure and uncontrolled inflammatory response. It is associated with high risk of death for the fetus.


METHODS
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(rd) 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(th) week of pregnancy, the gestational hormone levels increased to the values appropriate for such fetal age. The development of pregnancy was also confirmed 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 first successful administration of activated protein C in 21-day pregnancy.
Mikaszewska-Sokolewicz
Małgorzata
M
1st Department and Chair of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland. mms@anest.pl
Mayzner-Zawadzka
Ewa
E
D018806:APACHE; D000328:Adult; D002302:Cardiac Output; D005260:Female; D006339:Heart Rate; D006801:Humans; D016471:Ovarian Hyperstimulation Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D010976:Platelet Count; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000503:physiopathology; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology*; D013318:Stroke Volume; D016896:Treatment Outcome
D011486:Protein C; D011994:Recombinant Proteins