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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
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• 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
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• Prompt resuscitation.
• Adequate nutrition.
• Meticulous sepsis prevention/management.
• Co-management with the obstetrician.
• Wound cover are vital for improved
outcome.
BACKGROUND
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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.
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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.
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PRESENTATION (2)
• First aid comprised of water and raw
eggs smeared on the wounds.
•She was pregnant, G2P1, EGA 27
weeks
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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.
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• 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)
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INITIAL DIAGNOSIS
Diagnosis was 40% deep partial
thickness flame burn injury due
to kerosene explosion in a 27
weeks gravid patient.
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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
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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.
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MULTIDISCIPLINARY CARE
•The Obstetricians were invited to
co-manage the patient.
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2DOA
• Fluid input/ Output = 6000mls / 450mls
(Inadequate)
• Investigations – Not done.
• Voluntary financial contributions by the
managing team were made.
• Social Welfare Unit was notified.
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• 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)
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• 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)
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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.
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• 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)
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• 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)
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• 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)
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•On the same day (7DOA), she
discharged herself against medical
advice; citing distance from her
relatives as the reason.
REQUEST FOR DISCHARGE
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BURDEN OF CARE
• PREGNANCY
• INDIGENT PATIENT
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BURDEN OF CARE (2)
• IGNORANCE
Refilling a lit kerosene stove, first
aid, unaware of retroviral status, self-
discharge
RETROVIRAL STATUS
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• 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
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CONCLUSION
This typifies some challenges faced in
burn management in our sub region.
Outcome measures are usually not
feasible.
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DESPITE THESE OBSTACLES,
WE WILL ATTAIN GREAT
HEIGHTS
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THANK YOU
FOR YOUR
ATTENTION