Occurrence of septic shock in a patient submitted to emergency cerclage following a negative amniocentesis: report of a case.
BACKGROUND
Second trimester emergency cerclage is an option for pregnant women presenting bulging fetal membranes. Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported. Exclusion of infections through preprocedure amniocentesis has been proposed.


METHODS
A 37-year-old woman, gravida 4 para 1, was admitted at 21 weeks of gestation to our University Hospital due to bulging fetal membranes. An amniocentesis was performed in order to exclude an actual amniotic infection. Our Microbiology Department found a negative amniotic culture for bacteria and Mycoplasma and a normal glucose and interleukin-6 level, so a cervical cerclage was performed. The patient was discharged home on oral erythromycin.


RESULTS
After 48 h, the patient complained of hyperpyrexia, shivers and reduced fetal movements. Ultrasound at admission showed absent cardiac activity and after cerclage removal a non-viable fetus was delivered vaginally. Piperacillin and tazobactam were started, but the clinical course of the patient deteriorated and she developed a cold septic shock and was submitted to hysterectomy and transferred to the ICU of our hospital.


CONCLUSIONS
This report heralds that even after negative amniocentesis, a life-threatening infection may not be excluded in women candidate for emergency cerclage due to bulging fetal membranes.
Department of Obstetrics and Gynecology, University Hospital, Bologna, Italy. tullioghi@yahoo.com
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Ghi
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Bellussi
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Curti
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Youssef
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Bianchi
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De Eccher
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Turchi
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Rainaldi
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De Iaco
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Pilu
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Rizzo
D000328:Adult; D000649:Amniocentesis; D023802:Cerclage, Cervical / Q000009:adverse effects*; D003951:Diagnostic Errors; D004638:Emergency Treatment; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology; D005321:Extraembryonic Membranes / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000517:prevention & control; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology; D011262:Pregnancy Trimester, Second; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome