| Day of Hospitalization Gestational age | Evolution and management |
| D1 to D6 20w5d to 21w3d | Treatment with antibiotics was maintained. Received pulses of intravenous (IV) immunoglobulin for 5 days. Cervical length: 24 mm. |
| D7 to D20 21w4d to 23w3d | Nifedipine for tocolysis and prophylactic enoxaparin were started. Negative urinalysis and normal morphological ecography. |
| D21 to D36 23w4d to 25w6d | Indomethacin for tocolysis at D21. At 24 weeks, two doses of intramuscular betamethasone were prescribed. New pulse of IV Immunoglobulin for 5 days. Obstetric ultrasound with fetus on percentile 10 and normal Doppler. |
| D37 to D53 Gestational age: 26w to 28w | Third pulse of IV Immunoglobulin for 5 days. Intravenous Salbutamol was used for contractions. At 26 weeks, new dose of Indomethacin for 2 days for tocolysis. |
| D54 to D59 28w to 29w | Due to increased vaginal discharge, Azithromycin and Ampicillin were prescribed. Reapplication of intramuscular betamethasone at 28 weeks and suspension of Nifedipine. Premature rupture of membranes at 28 + 4 weeks (D57). Removal of cervical pessary. Bacteriological of the vaginal secretion showed Klebsiella, Enterococcus and Citrobacter. C-section is indicated due to pelvic presentation and labor onset. |
| D60 to D63 29w to the 2nd day of puerperium | Cesarean section at 29 + 1 weeks. Female newborn, 1400 grams. Treatment for vaginal discharge with Cefepime, Amikacin and Clindamycin was started. Feverish peaks in first day of puerperium, with normal chest X-ray and leukocytosis. New dose of IV Immunoglobulin is administered and previous antibiotics are exchanged for Vancomycin and Meropenem. Because of severe sepsis and probable puerperal endometritis, patient is transferred to the Intensive Care Unit (ICU). Ultrasound of the abdomen showed heterogeneous contents in the uterine cavity. Diagnosis of septic thrombophlebitis. |
| Day of Hospitalization Day of Puerperium |
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| D64 to D68 3rd to 7th day | Discharge from ICU at D64 of hospitalization. Full dose of unfractionated heparin for pelvic septic thrombophlebitis was started. New febrile peaks despite use of Meropenem and Vancomycin. Worsening of the medical condition, with increased vaginal bleeding and pain on mobilization of the uterine cervix and at decompression of left iliac fossa. Surgical wound infection (Figure 1) Hysterectomy with bilateral salpingectomy and left oophorectomy was performed at D68. |