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BURN IN PREGNANCY –

A CASE REPORT

ARIA ON, AMIRIZE EE, KEJEH BM, GBENEOL T

University of Port Harcourt Teaching Hospital, Nigeria

• Major burn injuries are greatly

traumatizing and more so, in the

pregnant patient with burns.

• The TBSA is a major determinant of

maternal survival; while fetal survival is

largely dependent on the gestational

age and maternal TBSA .

BACKGROUND

• Prompt resuscitation.

• Adequate nutrition.

• Meticulous sepsis prevention/management.

• Co-management with the obstetrician.

• Wound cover are vital for improved

outcome.

BACKGROUND

AIM

To highlight the challenges

encountered in the

management of this burn

injured pregnant patient; as

well as to share our action plan

to prevent such challenges.

CASE PRESENTATION

• Miss A. B, a 29 year old single lady,

secondary school drop out.

• With Flame burn injury of 8 hours

duration.

• Flame source was kerosene stove

explosion.

PRESENTATION (2)

• First aid comprised of water and raw

eggs smeared on the wounds.

•She was pregnant, G2P1, EGA 27

weeks

EXAMINATION

• At presentation , she was in painful

distress, afebrile, pale, dehydrated, no

pedal edema.

•Weight 60kg.

• Airway- clear.

• She had no obvious signs of inhalation

injury.

• Respiratory rate - 24 cpm

• Pulse rate - 108 pm

• Blood pressure - 100/60 mmHg

• Temperature - 37 Co

• Affected areas were the face/neck,

torso/limbs, with mainly deep partial

thickness burn injury of TBSA 40%.

EXAMINATION (2)

INITIAL DIAGNOSIS

Diagnosis was 40% deep partial

thickness flame burn injury due

to kerosene explosion in a 27

weeks gravid patient.

PLAN (RESUSCITATION)

• Fluid resuscitation (parkland formula;

9,600mls over the next 16 hours)

• Urine output monitoring ( 30mls/ hour)

• Analgesia

• IV Omeprazole, Vitamins A, C, E.

• Tetanus prophylaxis

PLAN (2)

• FBC, serum electrolytes, urea and

creatinine, urinalysis, wound swab for MCS,

total protein albumin.

• High protein, high calorie diet.

• Burn wounds were copiously irrigated with

0.9% saline, and dressed with vaseline

soaked gauze.

MULTIDISCIPLINARY CARE

•The Obstetricians were invited to

co-manage the patient.

2DOA

• Fluid input/ Output = 6000mls / 450mls

(Inadequate)

• Investigations – Not done.

• Voluntary financial contributions by the

managing team were made.

• Social Welfare Unit was notified.

• Hemoglobin concentration was 7g/dl;

serum electrolytes were within normal

range, but urea and creatinine were

mildly elevated.

• Ultrasound scan revealed an active live

fetus, at 72hours post injury. EGA 26

weeks.

INVESTIGATIONS (3DOA)

• A wound swab was sent for MCS

• During cross-matching and blood

screening, the patient tested positive to

HIV.

• A CD 4 count was requested for.

INVESTIGATIONS (2)

COMPLICATIONS

• 5th

day on admission - Intra-uterine fetal

demise; she spontaneously expelled the

fetus same day.

• She was transfused with 2 units of blood.

• Two men who had claimed responsibility

for her pregnancy, had stopped visiting.

• 6DOA- MCS yielded moderate growth of

Pseudomonas aeruginosa.

• Intravenous Ceftazidine 1 gram 12 hourly

was prescribed.

• IV Metronidazole 500mg 8hourly was

added.

• She was worked up for wound

debridement

COMPLICATIONS(2)

• On the 7th day on admission, she was

noticed to be febrile (39 Co), tachycardia

of 120bpm, with facial fullness and

pedal edema.

• Urine was concentrated, with a urine

output of about 12mls/hour.

COMPLICATIONS(3)

• A diagnosis of 40% deep partial thickness

flame burn injury, complicated by sepsis and

suspected Acute Kidney Injury in a newly

diagnosed RVD patient was made at this point.

• Renal function tests were requested for .

• The nephrologists were invited to co- manage .

COMPLICATIONS(4)

•On the same day (7DOA), she

discharged herself against medical

advice; citing distance from her

relatives as the reason.

REQUEST FOR DISCHARGE

BURDEN OF CARE

• PREGNANCY

• INDIGENT PATIENT

BURDEN OF CARE (2)

• IGNORANCE

Refilling a lit kerosene stove, first

aid, unaware of retroviral status, self-

discharge

RETROVIRAL STATUS

• Appeal to the hospital management for

emergency burn care in the first 48 hours.

• Solicit for support from NGOs

• More vigorous burn prevention awareness

campaigns

ACTION PLAN

CONCLUSION

This typifies some challenges faced in

burn management in our sub region.

Outcome measures are usually not

feasible.

DESPITE THESE OBSTACLES,

WE WILL ATTAIN GREAT

HEIGHTS

THANK YOU

FOR YOUR

ATTENTION