Case Of Methylene Blue In Severe Obstetric Sepsis

1. Case Of Methylene Blue In Severe Obstetric Sepsis This is a case of 23 years old G2P1 who was transfered to a tertiary unit at 23weeks+3 days following premature repture of membranes.In the past history she has previous normal vaginal delivery and one week before this admission she was treated with antibiotics for urinary tract infection.She was given steriods and counselled about fetal loss and decided for delivery with no fetal resuscitation.On the following day she started be pyrexial and tachycardic and was moved to the labourward.She started on intravenous antibiotics following blood culturs.Shedeliverd a stillborn later that day but suddenly deteriorated with septic shock and hypotension not responsive to fluid resuscitation.She also reported chest pain and was transferred to the intensive care unit.Her antibiotics were reviewed and changed.She needed adrenalin infusion and ended up with intubation.Imaging proved lung consolidation and she had coagulation system failure as we as renal failure with deranged liver function.She had persistent hypotenstion despite steroids and vasopressin with worsening lactic acidosis.Despite adding doxapamine her systemic vascular resistance(SVR) dropped persistently to 200. Methylene blue was started at 1mg/kg blous and the infusion of 0.25mcg/kg/h.Her SVR improved to 800 with remarkable immediate improvement in the acid base balance and cardiac index.Her cultures grew E Coli and over 24h she was further improving with decreased requirement of ionotrops.She was extubated in 48h and her DIC was treated with blood products.She was fully conscious but developed severe facial herpes which was treated with acyclovir intravenously.She was dischared on day 8 from her hospital admission.Sepsis started to jump the ladder a case of maternal morbidity and mortality.Many units including our unit have developed sepsis bundle system of awarness and prompt timely management of sepsis before it get to the stage of mutliorganfailure.Methylene blue has long been used in cases of malaria and series started to show its value in severe hypotension due to sepsis by normalising NO content.In addition to the blue coloration of tissues it could worsen coagulation problems.There is no documented role in using it prophylactically and it is still can be considered as desperate measure to try in protracted cases due to the need of more strong evidence.