The patient was a 28-year-old woman who was referred to our Burn Institute 1.5 h after a flame burned her head, trunk, and limbs. The patient had a distressed facial expression and was cooperative in the physical examination. She had no breathing difficulty, although obvious swelling, particularly on the head, was observed. No ashes or blisters were found on the oropharyngeal mucosa by laryngoscopy examination. Physical examination data on admission were as follows: body weight, 56 kg; blood pressure, 132/67 mmHg; pulse rate, 88 bpm; body temperature, 36.8 C; and respiratory rate, 15 bpm. The burn wounds were distributed on the face, neck, trunk, and limbs, and the total burn area was 50% TBSA. Wounds were presented as red, or red and white in appearance, and parts of them were dry with diminished sensation. The laboratory results were as follows: blood routine examination: WBC, 18.64 x 109/L; neutrophil granulocyte, 90.3%; Hgb, 105 g/L; RBC, 4.03 x 1012/L; Hct, 0.329; platelet, 296 x 109/L. The liver and kidney function indexes were all in the normal range except that the total protein level was 50 g/L and the albumin level was 24 g/L. The obstetric examination results were as follows: The patient was 35 weeks and 5 days pregnant, the uterine fundus was halfway between the umbilicus and xiphoid process, and the fetal outline was palpable. No vaginal bleeding or discharge was observed, and uterine contraction was not palpable. Fetal movements were occasionally felt. The cervix was not open, and the fetal membranes had not broken. The fetal heart rate (FHR) was 150 bpm. There was no gestational hypertension, gestational diabetes, or other combined diseases reported. The admission diagnosis was that the flame burned 50% TBSA (superficial second-degree 20% TBSA, deep partial thickness burn 30% TBSA) with a third-trimester pregnancy.
During emergency treatment, lactate Ringer's solution was infused for fluid resuscitation, and 1,500 mL of lactate Ringer's solution was infused during the first 9 h after injury. The burns were covered with Vaseline gauze after simple wound cleaning. Nine hours after the injury, after consulting and discussing with the obstetrician, a cesarean section was performed under spinal epidural anesthesia, and a live baby girl was delivered. The surgery lasted approximately 1 h, and the blood pressure was stable during the surgery. The Hgb level after the surgery was 97 g/L. The baby had a body weight of 2,220 g and a body length of 46 cm with APGAR scores of 10', 10', and 10'. The vital signs of the patient were stable during surgery. After delivery of the baby, intravenous fluid resuscitation was continued for the patient using the Ruijin (Resuscitation) formula. Ruijin's formula involves the infusion of a crystalloid solution, which comprised primarily lactated Ringer's solution and/or colloids, usually plasma, at a rate of 1.5 mL/kg/percentage of the burned body surface area for the first 24 h and half of the amount of the actually infused crystalloid and colloid solution for the second 24 h. In addition, 2,000~3,000 mL of physical-demanding water was applied every 24 h after injury. The type and volume of the solution delivered for liquid resuscitation are summarized in Table 1. The hourly urine output was 50~350 mL during the first 48 h after the burn injury. The treatment for the patient included the application of silver sulfadiazine cream on the wounds when the dressing was changed every 2 days, infusion of imipenem for the antimicrobial prophylaxis of infection, and administration of oxytocin and Chinese herbal medication to promote uterine involution. No systemic infection or dysfunction of internal organs was found during the patient's stay in the hospital. The patient discharged herself without postpartum complications at 15 days after injury due to financial reasons. At discharge, the superficial second-degree and part of the deep partial thickness burn wounds that were relatively superficial were healed, and less than 10% TBSA deep partial thickness burn wounds remained on the neck, right upper limb, and both legs. No signs of difficulty of healing that could imply the connection of impaired healing and pregnancy were observed. Physical examination results were as follows: blood pressure, 119/76 mmHg; pulse rate, 90 bpm; body temperature, 36.4 C; and respiratory rate, 17 bpm. Laboratory results were as follows: blood routine examination: WBC, 8.76 x 109/L; neutrophil granulocyte, 71.3%; Hgb, 111 g/L; RBC, 4.12 x 1012/L; Hct, 0.337; platelet, 359 x 109/L; glutamic pyruvic transaminase, 19 IU/L; glutamic-oxalacetic transaminase, 23 IU/L; alkaline phosphatase, 81 IU/L; TP, 71 g/L; albumin, 36 g/L; urea nitrogen, 3.6 mmol/L; creatinine, 37 mumol/L.