This case involves a twenty-seven-year-old postpartum patient who presented to labor and delivery with chorioamnionitis. She was being treated as an outpatient after delivery with oral antibiotics. Four to five days after delivery, the patient developed shortness of breath. A chest x-ray was obtained, and no abnormalities were appreciated. Respiratory therapy (RT) was then consulted. RT gave a dose of nebulized albuterol to dilate the airway. After administering the dose, the RT technologist departed. The patient symptoms worsened, and she pressed the nurse call button, but no one, immediately, responded. When the nurse checked back on the patient, she was in severe respiratory distress. Her condition deteriorated to cardiopulmonary arrest and ACLS protocols were initiated. The patient expired shortly thereafter.
Question(s) For Expert Witness
- 1. What concerns should the treating parties have been aware of?
Expert Witness Response
Intra-abdominal amniotic infection (IAI) (chorioamnionitis) is associated with an increased risk of labor abnormalities, uterine atony, postpartum hemorrhage, and endometritis. The type of infection appears to play a role: women with persistent high-virulence organisms in their amniotic fluid have more labor abnormalities than women with low-virulence organisms. The risk of life-threatening sequelae, such as sepsis, coagulopathy, and adult respiratory distress syndrome related to IAI, are low if treatment with broad-spectrum antibiotics is initiated. Unfortunately, despite empiric antibiotic treatment, IAI does progress to respiratory distress as in this instance. A patient with breathing difficulty and history of IAI/chorioamnionitis should be aggressively treated as any other patient with ARDS.