title: Morbidly obese woman unaware of pregnancy until full-term and complicated by intraamniotic sepsis with pseudomonas.
abstract: A 32-year-old Caucasian woman of body mass index (BMI) 46 presented with urinary symptoms to accident and emergency (A&E). Acute pyelonephritis was the diagnosis. Transabdominal scan revealed a live term fetus. Both the partners were unaware of the ongoing pregnancy until diagnosed. She underwent emergency cesarean under general anaesthesia (GA) for nonreassuring CTG, severe chorioamnionitis, and moderate preecclampsia. A live male baby weighing 4400 grams delivered in poor condition. Placental tissue on culture exhibited scanty growth of pseudomonas aeruginosa. Chorioamnionitis due to pseudomonas is rare, with high neonatal morbidity and mortality. It is mostly reported among preterm prelabor rupture of membranes (PPROM). Educating the community especially morbidly obese women if they put on excessive weight or with irregular periods should seek doctor's advice and exclude pregnancy. For the primary care provider, it is of great importance to exclude pregnancy in any reproductive woman presenting with abdominal complaints. This case also brings to clinicians notice that pseudomonas can be community-acquired and can affect term pregnancies with intact or prolonged rupture of membranes.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Albert Edward Infirmary, Wigan Lane, Wigan WN1 2NN, Lancashire, UK. drmuppala@dochdoc.com
authors.forename: H
authors.initials: H
authors.lastname: Muppala
authors.forename: J
authors.initials: J
authors.lastname: Rafi
authors.forename: I
authors.initials: I
authors.lastname: Arthur
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000150:complications; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009767:Obesity, Morbid / Q000150:complications*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000503:physiopathology; D011552:Pseudomonas Infections / Q000150:complications* / Q000175:diagnosis; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology