RCOG World Congress 2023

A rare case of ascites and pleural effusion following emergency caesarean section

Natasha Warren, Tina Thanawala, Gayatri Ranjan, Chidimma Kanu

East and North Herts Trust

Case Report – Intrapartum

•32 year old para one presented with vaginal bleeding at 40+6

•Admitted for balloon IOL

•Had Category 2 Caesarean section for suspected placental abruption following CTG concerns and further bleeding

•1400mls blood loss but otherwise uncomplicated

Case Report – Postnatal D1-15

•Temperature spike on D3 lasted until D15 despite multiple IV antibiotics

•D3 had CTPA - NAD

•Treated for pyrexia of unknown origin

•Had CXR which showed pleural effusion and cardiomegaly

•Cardiology ruled out cardiac failure

•D10 had USS which showed ascites and normal uterine appearance for 10 days post section

Case Report – Postnatal D15-31

•CT repeated on D17 showed large volume ascites

•Drained twice by Interventional Radiology

•As still spiking temperatures following MDT discussion decision for return to theatre for washout

•No further temperatures post-operatively

•Home on D31

CXR showing left lower lobe collapse and left pleural effusion

CT image showing

large volume of abdominal free fluid

Discussion

•Pleural effusion and ascites have multiple causes:

•Malignancy

•Liver cirrhosis

•Cardiac failure

•Post-operative complications

•Infection

•Inflammatory causes

•Following multiple investigations all ruled out except infection and inflammatory causes in this case

•MDT input essential to recognise complex post-operative complications and select treatment strategies

•This patient had input from General Medicine, Gastroenterology, General Surgeons, Cardiology and Interventional Radiology

•MBBRACE 2022 reiterated importance of MDT working to prevent maternal mortality in complex cases as highlighted here.

Conclusion

•Pleural effusion and ascites are a rare complication of caesarean section

•Important to rule out potential causes including iatrogenic injury before attributing to infection and inflammatory causes

•Patients might not make a full recovery until a washout has been performed

A rare case of ascites and pleural effusion following emergency caesarean section