Use of intravenous immunoglobulins in an obstetric patient with septic shock: Case report and review of the literature
DOI:
https://doi.org/10.18597/rcog.1095Keywords:
Sepsis, intravenous immunoglobulins, septic shockAbstract
Objective: To report the case of an obstetric patient who developed septic shock secondary to a gastrointestinal infection, and the use of intravenous immunoglobulin (IVIG) as an adjunct, and to conduct a review of the published literature on the use of immunoglobulins in septic shock with emphasis on its use during pregnancy.
Materials and methods: Case report of a patient with 36 weeks of gestation who presented with septic shock secondary to a gastrointestinal infection resulting in multiple organ failure. In view of poor response to treatment, adjunctive therapy with IgM-enriched immunoglobulin therapy was initiated, achieving good response. A search of the literature was conducted in the Medline, Direct Science, Cochrane Library and SciELO databases using Health Science Descriptors (DeCS) such as intravenous immunoglobulin and sepsis in pregnancy.
Results: Six articles directly related to the use of IVIG in sepsis during pregnancy were found, including 1 review, 2 case reports and 3 diagnosis and management guidelines. Intravenous immunoglobulins have been used with greater frequency in non-obstetric patients in septic shock as an adjunct in cases of poor response to treatment, especially in streptococcal and staphylococcal infections.
Conclusion: Intravenous immunoglobulins could be an alternative as adjunct therapy in the management of septic shock in pregnant women who respond poorly to conventional treatment. Analytical studies including pregnant women are needed in order to confirm these findings.
Author Biographies
Olga Lucía Cuero-Vidal
Médico especialista en Obstetricia y Ginecología; magíster en Epidemiología, Servicio de Obstetricia y Ginecología, Asistencial Hospital San Juan de Dios. Docente Universidad Javeriana Cali, Grupo Investigación Integral Médica (GIIM), Cali (Colombia).
linary67@hotmail.com
Diego Fernando Moreno-Sánchez
María del Mar Torres-Bejarano
Johana Alejandra Moreno-Drada
References
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelinesfor the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864-74.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al; 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003;29:530-8.
Gómez JC. Actualización del marco conceptual y manejo de la sepsis, sepsis severa y shock séptico. Rev Med Fac. 2009;17:116-29.
Bamfo JE. Managing the risks of sepsis in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27:583-95. doi: 10.1016/j.bpobgyn.2013.04.003.
Kramer HM, Schutte JM, Zwart JJ, Schuitemaker NW, Steegers EA, et al. Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta Obstet Gynecol Scand. 2009;88:647-53.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2:e323-33. doi: 10.1016/S2214-109X(14)70227-X
Cordioli RL, Cordioli E, Negrini R, Silva E. Sepsis and pregnancy: do we know how to treat this situation? Rev Bras Ter Inten. 2013;25:334-44.
Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:980-1004. doi: 10.1016/S0140-6736(14)60696-6.
Alcaldía Mayor de Bogotá D.C. Guía de sepsis en obstetricia – Secretaría Distrital de Salud. Bogotá. 2013 [visitado 2016 Ago 1]. Disponible en: http://www.saludcapital.gov.co/DDS/Publicaciones/Guia %20Maternidad-Sepsis_baja.pdf
Sung E, George J, Porter M. Sepsis in pregnancy. Fetal and Maternal Medicine Review. 2011;22:287-305.
Ooe K, Udagawa H. A new type of fulminant group A streptococcal infection in obstetric patients; report of 2 cases. Hum Pathol. 1997;28:509-12.
Snyder CC, Barton JR, Habli M, Sibai BM. Severe sepsis and septic shock in pregnancy: Indications for delivery and maternal and perinatal. J Matern Fetal Neonatal Med.2013;26:503-6. doi: 10.3109/14767058.2012.739221.
Barañao RI. Inmunología del embarazo. Invest Clin. 2011;52:175-94.
Royal College of Obstetricians and Gynaecologists. Bacterial sepsis in pregnancy. Green-top Guideline,No. 64; 2012.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:583-637. doi: 10.1097/CCM.0b013e31827e83af.
Norbby-Teglund A, Haque KN, Hammarstrom L. Intravenous polyclonal IgM-enriched immunoglobulin therapy in sepsis: A review of clinical efficacy in relation to microbiological aetiology and severity of sepsis. J Intern Med.2006;260:509-16.
Alejandria MM, Lansang MAD, Dans LF, Mantaring JB 3rd. Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock. Cochrane Database Syst Rev. 2013;(9):CD001090. doi: 10.1002/14651858.CD001090.pub2.
Loza Vázquez A, León Gil C, León Regidor A. Nuevas alternativas terapéuticas para la sepsis grave en el paciente crítico. Revisión Med Inten. 2011;35:236-45. doi: 10.1016/j.medin.2010.10.002.
Hamano N, Nishi K, Onose A, Okamoto A, Umegaki T, Yamazaki E, et al. Efficacy of single-dose intravenous immunoglobulin administration for severe sepsis and septic shock. J Intensive Care. 2013;1:4. doi:10.1186/2052-0492-1-4. eCollection 2013.
Anderson BL. Puerperal group A streptococcal infection: Beyond semmelweis. Obstet Gynecol. 2014;123:874-82. doi:1097/AOG.0000000000000175.
Izdes S, Altintas ND, Eldem A, Ceyhan H, Kanbak O. Intravenous polyclonal IgM-enriched immunoglobulin therapy for resistant Acinetobacter sepsis in a pregnant patient with ARDS due to H1N1 infection. Int J Obstet Anesth. 2011;20:99-100. doi: 10.1016/j.ijoa.2010.09.001.
Al-Rawi S, Woodward LJ, Knight J. Puerperal streptococcal toxic shock syndrome treated with recombinant human activated protein C and intravenous immunoglobulin. Int J Obstet Anesth. 2009;18:169-72. doi: 10.1016/j.ijoa.2008.
South Australian Perinatal Practice Guidelines. Sepsis in pregnancy; 2014.
Sánchez Padron A, Sánchez Valdivia A, Somoza García M, Pérez Sánchez L. La sepsis grave en la paciente obstétrica. Guías Clínicas Breves; 2012.
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