2026 FSA Podium and Poster Abstracts

INTRODUCTION: Premature rupture of membranes (PROM) is defined as the rupture of fetal membranes prior to the onset of labor contractions. Spontaneous labor frequently begins soon after rupture of membranes (ROM) if the fetus is at term. However, if PROM occurs before 37 weeks, it is defined as preterm PROM (PPROM). When delivery does not follow PROM promptly, the risk of obstetric complications, such as intraamniotic infection and placental abruption, increases significantly1. PPROM presents a clinical challenge, requiring clinicians to carefully weigh the maternal risks of prolonging the pregnancy against the fetal risks associated with prematurity and the risk of the parturient developing chorioamnionitis2. Chorioamnionitis has serious maternal and fetal consequences and can quickly advance to septic shock, qualifying it as a true surgical emergency. 

CASE: This is a case of a 37yo F G3P0010 at 21w5d with a past medical history of PCOS presenting to the OBED for 1 day of painful uterine contractions and leakage of vaginal fluids. Obstetric history included cervical insufficiency for which she had an abdominal cerclage in place, as well as previous PPROM at 15wks with spontaneous abortion. Patient had an active bacterial vaginosis infection and reported being treated with metronidazole. She additionally reported taking vaginal progesterone. Cervical exam was 0/0/-3 and sterile speculum exam showed abundant yellow/green discharge around the cervical os. Fetal tachycardia was noted at 165bpm. The patient was admitted for observation, broad spectrum IV antibiotics, and tocolytics (indomethacin). She initially presented normotensive and mildly tachycardic and remained so for the first 36 hrs after admission. However, she soon became febrile (Tmax 102.4) and tachycardic (145 bpm). Septic shock secondary to intraamniotic infection was suspected. The anesthesia team was notified, and emergency cesarean section was called secondary to suspected intraamniotic infection/sepsis in the setting of previable PPROM with abdominal cerclage in place at 22 weeks gestation. Patient underwent GETA with RSI using versed, fentanyl, ketamine, propofol, and succinylcholine and maintained on 0.5 MAC SEVO. A vasopressor (phenylephrine 1.0mcg/kg/min) was started intraoperatively and IVF fluid resuscitation continued. Pt responded well to a 4L LR bolus and was able to be weaned off pressors by end of the case and extubated. A TAP block was performed prior to extubation.

DISCUSION/CONCLUSION: Anesthetic agents and interventions may worsen the hemodynamics of the parturient in shock, therefore all possible efforts should be made to maintain organ perfusion supporting hemodynamics with fluids, vasoactive agents, and inotropes if necessary3. Preoperative fluid bolusing and optimization of preload/hemodynamics is the cornerstone of successful treatment of these patients. The obstetric patient population is generally young and healthy, so are able to compensate hemodynamically for a period of time. Neuraxial anesthesia is generally contraindicated in these patients due to risk of worsening of hemodynamic status. There is also increased risk of local infection or meningitis with the insertion of a needle in septic patients4. Additionally, general anesthesia was employed due to the psychological toll of a non-viable fetus.