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Severe ischaemic gangrene of scalp in an extreme preterm: a fatal case of combined aetiology
  1. Antonio Pérez-Iranzo1,2,
  2. Vicente Olaya Alamar1,
  3. Luz M Mira Ferrer1,3 and
  4. Andrea Nos Colom1
  1. 1NICU, General University Hospital of Castellon, Castellon de la Plana, Spain
  2. 2PICU, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  3. 3Obstetrics and Gynecology Service, General University Hospital of Castellon, Castellon de la Plana, Spain
  1. Correspondence to Dr Antonio Pérez-Iranzo; aperezi{at}


A 24+5-week preterm neonate with a severe scalp lesion was admitted to the neonatal intensive care unit (NICU) after caesarean section due to maternal chorioamnionitis (MC). An Arabin pessary had been inserted in addition to a previous cervical cerclage due to cervix insufficiency at 21+5 weeks of pregnancy (wp). At 23+5 wp, preterm rupture of membranes was evidenced. Both devices were kept to provide fetal viability. On 24+4 wp, she developed MC. Urgent caesarean section was performed. Transvaginal manual manipulation was required during the procedure. On NICU, she presented severe shock which required high-dose vasopressors and blood products. Following surgical repair, a bilateral grade IV intracranial haemorrhage was evidenced. Subsequently, it was agreed to withdraw life support. We hypothesise that MC and local infection could have acted as predisposing factors, with the presence of a pessary in the setting causing uterine contractions and its manipulation acting as a precipitating factor.

  • infections
  • obstetrics
  • gynaecology and fertility
  • skin
  • neonatal intensive care
  • paediatric surgery

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  • Twitter @Antonio Iranzo, @andreanosco

  • Contributors AP-I first conceived the idea of publishing this case, carried out correction, translated it to English and rewrote the final draft. VOA wrote the first draft of the article and improved the second draft. LMMF provided advise during the creation of drafts and revised the obstetric view of the article. ANC helped VOA during the creation of the first draft. All authors have validated the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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