Josephine* lay in bed struggling to breathe, the hiss of the oxygen flowing through the mask ominously indicating that things were not okay. The chest tube draining pus from her left lung was still active. The nurse adjusted the various intravenous solutions and walked away with a heavy heart.
Josephine was admitted to the antenatal ward on a cold rainy night with chest discomfort, fever and general ill health. She was 25 weeks pregnant with her first baby. Despite x-rays being prohibited in pregnancy, it was absolutely necessary that Josephine get one done to confirm her diagnosis. She lay on the x-ray table with a shield covering her abdomen to protect her baby.
After the tests, Josephine was found to have empyema, a condition where the lung is surrounded by pus from infection. An ultrasound showed that her baby was hanging in there. She needed to be nursed in the high dependency unit, but the unit was overwhelmed and she had to be nursed in our ward.
The cardiothoracic team came and put in a chest tube to drain the pus as she was started on strong antibiotics to treat the underlying infection. They raced against time to contain the nasty bugs causing chaos before they could migrate to the rest of the system and cause multi-organ system failure.
We were not winning the war. 48 hours after she was admitted, we lost the little one. In the face of the severe distress Josephine was in, she had to undergo induction of labour to deliver the baby, bringing the pregnancy to an end. This was meant to boost her fighting chance. The process took 16 harrowing hours while her body fought raging fever.
Thereafter, the fever broke and we thought there was light at the end of the tunnel. The respite was short-lived. Despite the empyema draining well and the fever breaking, Josephine didn’t seem to recover as fast as we expected. The chest physicians religiously attended to her despite the limitations of the institution.
About 10 days after she first came to us, the fever was back with a vengeance. Things got worse. All her laboratory parameters were off-kilter. She was breathless and needed intensive care, but we could only hope that a bed would be made available. She developed a red rash on her legs and the cardiologists joined the bandwagon of caregivers.
Despite the strong antibiotics, Josephine had developed infective endocarditis, an infection of the heart valves. The valves could not function properly and this led to heart failure. She was hovering on the brink and despite a ton of medications, the response was dismal.
Her mother sat quietly at her bedside, holding her hand, wiping her brow and turning on the bedside heater when Josephine became too cold. She prayed for her only daughter, lips moving silently as she beseeched God to let her daughter live.
In the wee hours of the morning, the intensive care unit called with good news; we could transfer Josephine to the ventilator. Her mother stoically walked beside the bed as she was wheeled out. She was intimidated by the idea of an admission to the ICU, but she was being strong for her daughter.
The ICU experience was stormy. Josephine fought with all she had, bolstered on by her mother’s will. However, the heart gave in. It could not survive the onslaught. The valves were heavily laden with vegetation (clumps of bacteria rolled up in a bundle of dead cells and fibrin) and could not effectively pump blood. Three weeks after she first came to us, Josephine quietly left this world.
It was devastating to lose two lives as a result of an easily preventable problem. Josephine’s complications arose from a simple tooth problem. A month earlier, Josephine had complained of toothache. She has ignored the discomfort and taken a painkiller. The pain settled for a few days and then recurred.
Josephine sought help at her local antenatal clinic and was given more painkillers. By the time she was seeing a dentist, she had to have the tooth extracted. Unfortunately, the prolonged infection was well on its way to developing the life-threatening complications. The infection extended to the lungs, causing the empyema while the bacteria found its way into the bloodstream and into the heart valves.
During pregnancy, it is normal for the immune system to intentionally weaken so as to protect the unborn baby from rejection by the mother. This is because 50 per cent of the baby is foreign to the mother. While this ensures a smooth pregnancy for the baby, the mother is more likely to handle infections poorly, with increased likelihood of complications.
Dental infections in pregnancy require to be handled by a qualified dentist. The dentist understands the delicate physiology of pregnancy, the various changes that occur in the gums and the precautions required to avert a crisis. The mother should diligently observe dental hygiene and seek care early to ensure good outcomes.
As my dentist always reminds me, the “old till you are toothless” adage is the greatest fallacy of all times. Teeth fall out due to ignored gum disease. Gum disease is exacerbated in pregnancy. Routine dental appointments should be scheduled during pregnancy to keep complications at bay. Healthy teeth are more than just a beautiful smile!