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Lovina Machado

Lovina Machado

Sultan Qaboos University Hospital, Oman

Title: Fulminant puerperal sepsis due to group A Streptococcus– Key management issues

Biography

Lovina Machado completed her medical studies from St. Johns Academy of Medical Sciences, Bangalore in 1984 and subsequently postgraduation from Kasturba Medical College, Manipal with honors in 1987 followed by MRCOG(UK) in 1999.She was awarded Fellowship of the Royal College of Physicians, Ireland in 2011 and Fellowship of the Royal College of Obstetricians & Gynaecologists, UK in 2012. Dr. Lovina joined the Dept of OBGYN at SQU in 1990 and has been one of the founder members involved in setting up the Department. Her special interests are maternal fetal medicine, high risk pregnancies and ultrasound. She is a popular teacher, actively involved in teaching, co-ordination, examination and curriculum design both for undergraduates and residents. She is the Assistant Program Director and Member of the Scientific Committee for Oman Medical Specialty Board (Ob/Gyn), the Examination and Curriculum sub-committees of OMSB ,Founder member of Oman Society of Obstetrics & Gynaecology and was Executive Committee Member of the Obstetrics & Gynaecology Club of Oman . In addition, she is a member of many Departmental, Hospital and College Committees. She is also involved in training doctors and technicians in basic obstetric & gynaecological ultrasound. She is a keen researcher and has over 30 publications in national and international peer reviewed journals and is also involved in many University funded and non-funded research projects. Dr. Lovina has also been an invited speaker at several national workshops and international conferences and has many international platform and poster presentations to her credit as well.

Abstract

Puerperal sepsis remains a leading cause of maternal mortality throughout the world. Group A streptococcal (GAS) infections are relatively rare with an incidence of 0.5 cases per 10,000 deliveries. The diagnosis can be elusive due to the varied and atypical presentation. This delay could be fatal due to the rapid, aggressive nature of invasive disease. Progression is associated with streptococcal toxic shock syndrome where mortality rates approach 40-60%. Postpartum women have a 20 fold increased incidence of GAS disease compared with non-pregnant women, most of them follow vaginal delivery and occur within the first 4 days postpartum. We present a 27 year old Omani lady who presented 2 days following a vaginal delivery with unremitting abdominal pain, septic shock, thrombocytopenia and deranged coagulation. Multiorgan involvement followed. After aggressive fluid replacement, IV broad spectrum antibiotics, resuscitation and correction of coagulation parameters, a subtotal hysterectomy, bilateral salpingectomy and partial resection of necrotic areas of both ovaries with thorough peritoneal lavage was performed. All cultures grew GAS. A stormy postoperative period followed. She was discharged home 19 days later. GAS related invasive infections in the form of endometritis, necrotizing fasciitis or streptococcal toxic shock syndrome. Toxins released spread along tissue planes causing necrosis. Awareness, early diagnosis, aggressive emergent management with fluid resuscitation and broad spectrum antibiotics (IV Benzyl Penicillin and Clindamycin) can be life-saving. A review of management issues, published guidelines and current protocols will be presented.

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