Successful prone positioning after recent caesarean section in severe ARDS with postpartum pulmonary haemorrhage

Abstract

Abstract A 35‐year‐old Thai women (gravida 3, para 0) at 36 weeks and five days of gestation was admitted to a delivery room due to premature rupture of membrane. She was diagnosed with Escherichia coli with extended‐spectrum beta‐lactamase (ESBL) chorioamnionitis and septic shock leading to signs of fetal distress. She underwent emergency caesarean section. Post‐operatively, the patient developed severe acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), massive pulmonary haemorrhage, and intra‐abdominal bleeding. Lung protective strategy and recruitment manoeuvres were applied; however, her oxygenation and haemodynamic parameters worsened. Twenty consecutive hours of prone positioning was performed as a rescue procedure to improve patient's oxygenation and allow the patient to undertake surgical re‐exploration for abdominal compartment syndrome management safely. Neither high ventilator setting nor re‐positioning was needed after the second operation.

Keywords

• Caesarean section
• postpartum stage
• prone positioning
• pulmonary haemorrhage
• severe ARDS