Symmetrical peripheral gangrene due to postpartum cardiomyopathy: A case series

Abstract

Background: symmetrical peripheral gangrene (SPG) of two or more extremities without large vessel obstruction or vasculitis is seen in various medical conditions. It has high morbidity with an increasing frequency of multiple limb amputations in survivors. Objective: The objective of these case series is to highlight SPG as a cause of multiple limb amputation and the benefits of a multidisciplinary team approach in its management. Methods: We report three cases of SPG caused by sepsis within the peripartum period. All the patients were referred to our facility because of progressive darkening of the extremities following unsupervised home deliveries. Two of the patients were booked multigravida with regular clinic visits at a peripheral hospital, while one is an unbooked primigravida. They all had urgent resuscitation and subsequent multiple amputations and disarticulations of affected extremities to save their lives. Multidisciplinary pain management involving nursing care, dietetics, physiotherapy, and social care was involved in the care of the patients till discharged. The pain intensity was measured to be at ten on the verbal rating scale (VRS) preoperation, and functional disability of 30% on Barthel’s index (BI). Results: Seven days post-operation, all the patients’ pain has remarkably reduced with an average VRS = 2 and enhanced functional disability BI = 70%. All three patients now ambulate on a pair of auxiliary crutches. Conclusion: Early recognition of symmetrical peripheral gangrene and prompt referral for immediate resuscitation and active treatment of sepsis may prevent further progression of the condition and, thus, saves the person’s life.