Maternal near-miss: recovery from refractory septic shock with multiple organ dysfunction secondary to acute pyelonephritis in pregnancy

Hong Chen^1*Guihua Chen²Ziyu Huang³Yaling Tang¹

• ¹First Affiliated Hospital of Xiamen University, Xiamen, China
• ²Department of Obstetrics and Gynecology, Zhangzhou Second Hospital of Traditional Chinese Medicine, Zhangzhou, Fujian 363000, People's Republic of China., 漳州市, China
• ³Xiamen University School of Medicine, Xiamen, China

Background: Urinary tract infections during pregnancy represent a significant clinical concern, posing considerable risks to both maternal and fetal health. The physiological changes associated with pregnancy increase the susceptibility to infections, with an estimated 15% to 20% of acute pyelonephritis cases potentially progressing to bacteremia, particularly in the context of urinary stones. The onset of sepsis may lead to septic shock and multiple organ dysfunction, adversely affecting the kidneys, liver, lungs, heart, and central nervous system. Recent research into the pathogenesis of sepsis has provided insight into how inflammation and the activation of immune responses can induce abnormalities in circulatory function, subsequently triggering systemic ischemia and resulting hypoxia. Case presentation: A 42-year-old pregnant woman presented with acute renal colic and fever, leading to the diagnosis of nephrolithiasis, hydronephrosis, and acute pyelonephritis. The clinical condition rapidly deteriorated, evolving into uroseptic shock, cardiogenic shock, and multiple organ dysfunction syndrome. This alarming progression necessitated her admission to the intensive care unit, where she received aggressive treatment interventions, including extracorporeal membrane oxygenation (ECMO), an intra-aortic balloon pump (IABP), and continuous renal replacement therapy (CRRT). Remarkably, these life-saving measures proved successful. After nine days in intensive care, she fully recovered and was discharged. Conclusion: This case study explores three critical clinical challenges: strategies for early identification of high-risk pregnant women for sepsis; optimal timing for interventions in obstructive urinary tract infections to prevent septic shock and multi-organ dysfunction; and the implementation of mechanical circulatory support. The circulatory support protocol highlights the importance of personalized interventions in complex medical scenarios.