Primigesta de 15 years old, with 40 weeks gestation, who was admitted to the Service of Obstetricia liquid [ObstetricsLA] presented the amalgamology of the Hospital Clínico San Borja Arria on May 11, 2008, to dilatation 05.
She had an early rupture of membranes 1 h 20 min before admission.
Pregnancy was regularly controlled in MaipúÆs anomaly and considered physiological.
Upon admission, the patient had a fever, normal blood pressure and pulse of 80 per min. Obstetric examination showed 5 cm dilatation, normal cardioconstrictive presentation (CMC), ruptured membranes, and CLFA with dye.
Pathological exams were not requested to search for infection because the patient had no compatible clinical manifestations.
Conduction anesthesia with continuous epidural and electronic monitoring was indicated, which revealed a variability of less than 5 FCL, a mean fetal heart rate of 150 beats per min and a prolonged variable deceleration per minute (up to 120 FCL).
He was reevaluated after another deceleration (60 FCL per minute for 7 min) and found 8 to 9 cm of dilation, cephalic presentation with bad odor II plane and LA meconium clumps.
The patient was immediately transferred to the delivery room with complete dilation and cephalic presentation in the third plane.
Vaginal delivery occurred at 7:24 h on May 11 (1 h 44 min after admission).
A newborn (NB) of 3-440 g of male sex, with very bad odor, very depressed with Apgar 1 at 1 minute and 3 at 5 min was obtained. The presence of meconium in the delivery was not described
Arterial cord blood showed pH 6.9, BE-25 and C02 35.
He was admitted to the neonatal intensive care unit with the following diagnoses: full-term NB suitable for gestational age, 40 weeks, severe perinatal asphyxia (American Association of Pediatrics criteria) and probable infection.
The newborn was always severely ill, with CNS involvement, hypoxic ischemic encephalopathy grade III, associated with early septic shock, multiple organ involvement and need for ventilatory support and vasoactive drugs.
At 24 h of life the hemocultives taken at birth were positive for Morganella morganii, changing the antibiotic ampicillin-sulphate scheme by cefoxime, according to the antibiogram.
Blood tests showed: C reactive protein 129 mg/L, lactic acid 138 mg/dL.
Chest radiography revealed bilateral parenchymal infiltrate compatible with bronchopneumonia.
The brain scan and ultrasound showed cerebral edema and hemorrhage of the left posterior fossa consistent with severely altered EEG, in convulsive status.
The neonate died at 17 days of life.
The autopsy revealed: full term NB, suitable for gestational age, with morphological signs of septic shock: disseminated intravascular coagulation, hepatic infarction, adrenal glands and splenic congestion.
Bilateral desquamative and hemorrhagic bronchitis.
Cerebral palsy with hypoxic-ischemic encephalopathy.
Placental biopsy revealed acute acalculous chorioamnionitis, acute funisitis and focal acute perivellositis.
The mother and child infected by Morganella morganii showed no clinical signs of infection, but a culture of positive lochii on the first day of puerperium.
She was discharged three days after delivery and treated with gentamicin 60 mg IM daily for 5 days.
The patient was monitored at 11 days of puerperium in the polyclinic of the Diagnostic Teraptic Center and was finally discharged in good physical condition.
