Successful Treatment with Drotrecogin alfa (activated) in a Pregnant Patient with Severe Sepsis

Sepsis remains one of the leading causes of mortality during pregnancy. Because of the inherent limitations of conducting scientific investigations during pregnancy, a great deal of clinical decision making is based on observational reports, an understanding of the physiologic changes of pregnancy, and consideration for risk to the fetus. We describe a 20-year-old pregnant woman at 20 weeks' gestation who was admitted to an obstetric ward for dehydration and a urinary tract infection. Approximately 36 hours later, the patient's clinical status deteriorated, with the development of mental status changes, acute respiratory failure, and renal failure. Drotrecogin alfa (activated) was started, as the patient's Acute Physiology and Chronic Health Evaluation II score was 27 (> 25 is the typical score required for drotrecogin alfa [activated] therapy); within 48 hours the patient's clinical status dramatically improved. The patient completed 96 uninterrupted hours of therapy and was subsequently discharged after a 15-day hospitalization, with no apparent sequelae. Approximately 17 weeks later, the patient gave birth to a 3.42-kg female infant with no congenital abnormalities. To our knowledge, this represents the second case report to describe the use of drotrecogin alfa (activated) along with the status of the mother and fetus both after completion of therapy and after subsequent delivery. Because of the threat of mortality from sepsis during pregnancy, combined with the inherent limitations associated with clinical research during pregnancy, further reports and investigation into the treatment of sepsis in the pregnant patient are warranted.