Application of citrate dialysis in the treatment of puerperal sepsis
Grigorii A. Penjoyan,
Margarita D. Andreeva,
Vladislav V. Ponomarev,
Sergei I. Goncharenko,
Emmanuella A. Bayanduryan,
Margarita G. Novosartian,
Fatima B. Kazanchi https://doi.org/10.25207/1608-6228-2020-27-1-135-145
Abstract
Aim. To describe the results of applying citrate dialysis in the complex therapy of a patient with postpartum sepsis.
Materials and methods. This paper presents an analysis of a case of the successful treatment of patient P. with the diagnosis “Childbirth 3 urgent. Pfannenstiel laparotomy. Caesarean section in the lower uterine segment. Hypotonic bleeding. Relaparotomy: ligation of the internal iliac arteries, hemostasis. Relaparotomy: additional hemostasis, pelvic tamponade, abdominal cavity tamponade. Hemorrhagic shock of fourth category. Extirpation of the uterus with tubes. Sepsis. Septic shock. DIC syndrome”. Citrate dialysis was included as part of intensive care therapy.
Results. Citrate dialysis allowed the patient with multiple organ failure, against the background of complex intensive care therapy, to restore kidney function after 28 sessions of renal replacement therapy. Diuresis was completely restored on day 42. Biochemical parameters, such as urea and creatinine, were normalized on day 45. The duration of treatment in the anesthesiology and resuscitation departments was 47 days, out of which lung mechanical ventilation lasted for 17 days. The total duration of treatment in the hospital was 54 bed days. The patient was discharged in satisfactory condition.
Conclusion. The methods of extracorporeal detoxifi cation can signifi cantly improve treatment outcomes in this category of patients and reduce maternal mortality rates.
About the Authors
Grigorii A. Penjoyan
Kuban State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Departmental Head, Department of Obstetrics, Gynaecology and Perinatology, Advanced Training and Occupational Retraining Faculty,
Mitrofanа Sedina str., 4, Krasnodar, 350063
Margarita D. Andreeva
Kuban State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Assoc. Prof., Prof., Departmental Head, Department of Obstetrics, Gynaecology and Perinatology, Advanced Training and Occupational Retraining Faculty,
Mitrofanа Sedina str., 4, Krasnodar, 350063
Vladislav V. Ponomarev
Kuban State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Assoc. Prof., Prof., Departmental Head, Department of Obstetrics, Gynaecology and Perinatology, Advanced Training and Occupational Retraining Faculty,
Mitrofanа Sedina str., 4, Krasnodar, 350063
Sergei I. Goncharenko
Region Clinic Hospital No 2
Russian Federation
Russian Federation
Departmental Head, Anesthesiology and Resuscitation Department,
Krasnykh partizan str., 6/2, Krasnodar, 350012
Emmanuella A. Bayanduryan
Kuban State Medical University
Russian Federation
Russian Federation
Post-graduate Student, Department of Obstetrics, Gynaecology and Perinatology, Advanced Training and Occupational Retraining Faculty,
Mitrofanа Sedina str., 4, Krasnodar, 350063
Margarita G. Novosartian
Kuban State Medical University
Russian Federation
Russian Federation
Post-graduate Student, Department of Obstetrics, Gynaecology and Perinatology, Advanced Training and Occupational Retraining Faculty,
Mitrofanа Sedina str., 4, Krasnodar, 350063
Fatima B. Kazanchi
Kuban State Medical University
Russian Federation
Russian Federation
Post-graduate Student, Department of Obstetrics, Gynaecology and Perinatology, Advanced Training and Occupational Retraining Faculty,
Mitrofanа Sedina str., 4, Krasnodar, 350063
References
1. Artymuk N.V Sepsis in obstetrics — 2017. Overview. Akusherstvo i Ginekologiya: Novosti, Mneniya, Obuchenie. 2017; 3(17): 61–65 (In Russ., English abstract).
2. Granatovich N.N., Volkov V.G. Sepsis in childbirth and the postnatal period as a cause of the regional maternal mortality rate. V.F. Snegirev Archives of Obstetrics and Gynecology. 2017; 4(1): 36–39 (In Russ., English abstract). DOI: 10.18821/2313-8726-2017-4-1-36-39
3. Lisonkova S., Potts J., Muraca G.M., Razaz N., Sabr Y., Chan W.S., Kramer M.S. Maternal age and severe maternal morbidity: A population-based retrospective cohort study. PLoS Med. 2017; 14(5): e1002307. DOI: 10.1371/journal.pmed.1002307
4. Shifman E.M., Kulikov A.V., Ovezov A.M. Sepsis during pregnancy and the puerperium. Obstetric Anesthesia Digest. 2018; 7(9): 4–17 (In Russ.).
5. Bonet M., Souza J.P., Abalos E., Fawole B., Knight M., Kouanda S., Lumbiganon P., Nabhan A., Nadisauskiene R., Brizuela V., Metin Gülmezoglu A. The global maternal sepsis study and awareness campaign (GLOSS): study protocol. Reprod. Health. 2018; 15(1): 16. DOI: 10.1186/s12978-017-0437-8
6. Shankar-Hari M., Phillips G.S., Levy M.L., Seymour C.W., Liu V.X., Deutschman C.S., Angus D.C., Rubenfeld G.D., Singer M.; Sepsis Defi nitions Task Force. Developing a New Defi nition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 775– 787. DOI: 10.1001/jama.2016.0289
7. Rhodes A., Evans L.E., Alhazzani W., Levy M.M., Antonelli M., Ferrer R., Kumar A., Sevransky J.E., Sprung C.L., Nunnally M.E., Rochwerg B., Rubenfeld G.D., Angus D.C., Annane D., Beale R.J., Bellinghan G.J., Bernard G.R., Chiche J.D., Coopersmith C., De Backer D.P., French C.J., Fujishima S., Gerlach H., Hidalgo J.L., Hollenberg S.M., Jones A.E., Karnad D.R., Kleinpell R.M., Koh Y., Lisboa T.C., Machado F.R., Marini J.J., Marshall J.C., Mazuski J.E., McIntyre L.A., McLean A.S., Mehta S., Moreno R.P., Myburgh J., Navalesi P., Nishida O., Osborn T.M., Perner A., Plunkett C.M., Ranieri M., Schorr C.A., Seckel M.A., Seymour C.W., Shieh L., Shukri K.A., Simpson S.Q., Singer M., Thompson B.T., Townsend S.R., Van der Poll T., Vincent J.L., Wiersinga W.J., Zimmerman J.L., Dellinger R.P. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive. Care. Med. 2017; 43(3): 304–377. DOI: 10.1007/s00134-017-4683-6
8. Krasnopolsky V.I., Logutova L.S., Buyanova S.N., Chechneva M.A., Akhvlediani K.N. Results of operative obstetrical activity in modern obstetrics. Zhurnal Akusherstva i Zhenskikh Boleznei. 2015; 14(2): 53–57 (In Russ., English abstract).
9. Ivannikov N.Y., Mitichkin A.E., Dimitrova V.I., Slyusareva O.A., Khlynova S.A., Dobrokhotova J.E. Modern approaches to the treatment of postpartum purulent-septic diseases. Medical Council. 2019; (7): 58–69 (In Russ., English abstract). DOI: 10.21518/2079-701X-2019-7-58-69
10. Strokov A.G., Poz Y.L. Clotting prevention in renal replacement therapy: classical approaches and new opportunities. Vestnik Transplantologii i Iskusstvennykh Organov. 2010; 12(4): 80–85 (In Russ., English abstract).
Review
For citations:
Penjoyan G.A., Andreeva M.D., Ponomarev V.V., Goncharenko S.I., Bayanduryan E.A., Novosartian M.G., Kazanchi F.B. Application of citrate dialysis in the treatment of puerperal sepsis. Kuban Scientific Medical Bulletin. 2020;27(1):135-145. (In Russ.) https://doi.org/10.25207/1608-6228-2020-27-1-135-145
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