Case report: group B streptococcal bacteremia and sacroiliitis after mid-trimester dilation and evacuation

Cardiovascular complications following medical termination of pregnancy: An updated review

BACKGROUND

Around 1 million cases of medical termination of pregnancy (MTP) take place yearly in the United States of America with around 2 percent of this population developing complications. The cardiovascular (CVD) complications occurring post MTP or after stillbirth is not very well described.

AIM

To help the reader better understand, prepare, and manage these complications by reviewing various cardiac comorbidities seen after MTP.

METHODS

We performed a literature search in PubMed, Medline, RCA, and google scholar, using the search terms "abortions" or "medical/legal termination of pregnancy" and "cardiac complications" or "cardiovascular complications".

RESULTS

The most common complications described in the literature following MTP were infective endocarditis (IE) (n = 16), takotsubo cardiomyopathy (TTC) (n = 7), arrhythmias (n = 5), and sudden coronary artery dissection (SCAD) (n = 4). The most common valve involved in IE was the tricuspid valve in 69% (n = 10). The most observed causative organism was group B Streptococcus in 81% (n = 12). The most common type of TTC was apical type in 57% (n = 4). Out of five patients developing arrhythmia, bradycardia was the most common and was seen in 60% (3/5) of the patients. All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery. Mortality was only reported following IE in 6.25%. Clinical recovery was reported consistently after optimal medical management following all these complications.

CONCLUSION

In conclusion, the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature. In this review, the most common CVD complication following MTP was noted to be IE and TTC.

Bilateral Erosive Septic Hip Arthritis Following Pregnancy

We report on a 34-year-old female whose normal spontaneous vaginal delivery was complicated by Group B streptococcus (GBS) colonization. She developed postpartum, bilateral, rapidly destructive septic hip arthritis. She was treated with bilateral articulating, antibiotic-impregnated spacers, 6 weeks of parenteral antibiotics, and subsequent conversion to total hip arthroplasties. In pregnant women, GBS can result in bacteremia, urinary tract infection, endometritis, and pneumonia. Less commonly, GBS can lead to endocarditis, sacroiliitis, or septic arthritis. Septic arthritis of the hip following pregnancy has been described in a limited number of case reports, yet none, to our knowledge, with rapid bilateral destruction requiring two-staged conversion to total hip replacement.

Group B Streptococcus tricuspid valve endocarditis with subsequent septic embolization to the pulmonary artery: A case report following elective abortion

Background

Tricuspid valve endocarditis caused by Group B streptococcus is a rare clinical entity with poor prognosis and has been previously reported following gynecologic procedures.

Case summary

We report a case of an 18-year-old female diagnosed with Group B streptococcus tricuspid valve endocarditis with septic emboli following an elective therapeutic abortion. After six weeks of treatment with ceftriaxone, she returned with recurrent symptoms and was found to have embolized a sizable vegetation to the pulmonary artery with probable lung infarction. She underwent surgical embolectomy and was treated with antibiotics and anticoagulation and was subsequently discharged in stable condition.

Conclusion

Group B streptococcus endocarditis is a serious complication of gynecologic procedures. The role of preoperative antibiotics, postoperative clinical suspicion of endocarditis based on respiratory symptoms and a multidisciplinary approach may lead to enhanced patient outcomes.

Group B streptococcus septic arthritis of the hip following spontaneous abortion

Group B streptococcus (GBS) infection of the hip in otherwise healthy adults is a rare entity that is previously only reported following peripartum gynaecological procedure and instrumentation. We report a case of infection of the hip with GBS following spontaneous abortion. Delay in identification of infection as the cause of pain ultimately leads to irreversible joint destruction. This case report will heighten the awareness of the first contact providers as well as orthopaedic surgeons to be more vigilant for possible septic complications associated with gynaecological procedures/complications and subsequent painful joints. To our knowledge, this is the only case report showing association of GBS infection in hip associated with spontaneous abortion.

Iliopsoas abscess: an unexpected sequela of dilation and evacuation

OBJECTIVE

This study aimed to report the case of a patient who developed an iliopsoas abscess after a dilation and evacuation for a midtrimester fetal demise.

MATERIALS AND METHODS

This is a case report of a 35-year-old woman who underwent a dilation and evacuation at 17 weeks' gestation because of a preterm premature rupture of membranes and fetal demise. Four days later, she presented with fevers, chills, malaise, and right lower back, hip, and thigh pain. Magnetic resonance imaging of the abdomen and pelvis revealed a 2.3 × 1.6-cm right iliopsoas abscess.

RESULTS

The patient underwent computed tomography-guided drainage of the abscess and made an uneventful recovery after completion of an antibiotic course and physical therapy.

CONCLUSIONS

An iliopsoas abscess should be considered in the differential diagnosis of any woman presenting with fevers, chills, and unilateral lower back, hip, and thigh pain in a radicular pattern after a recent dilation and evacuation.