Pueperal Sepsis Flashcards
Mortality rate of severe sepsis with acute organ dysfunction
20-40%
10% of all maternal deaths
3rd most common cause of direct maternal death
Risk factors for maternal sepsis
Obesity Impaired glucose tolerance/DM Impaired immunity/immunosupppressant medication Anaemia Vaginal discharge History of pelvic infection History of GBS infection Amniocentesis or other invasive procedures Cervical cerclage PROM GAS infection in close contacts/family members Black or other minority ethnic origin
Clinical signs of sepsis
Pyrexia Hypothermia Tachycardia Tachypnoea Hypoxia Hypotension Oliguria Impaired consciousness Failure to respond to treatment
Symptoms of toxic shock syndrome
Nausea Vomiting Diarrhea Pain out of proportion to clinical signs due to NEC Watery vaginal discharge Generalized rash-macular Conjunctival suffusion
Tasks within the first 6 hours of severe sepsis
Blood cultures prior to abx
Broad spectrum Abx w/in 1 hour
Measure lactate
IVF 20ml/kg if high lactate or hypotensive
May require vasopressors-maintain MAP.65mmhg
If still hypotensive: CVP>8mmhg and scvO2 >60%
Indications for transfer to ICU
Hypotension or raised serum lactate/need for inotrope support Pulmonary oedema Mechanical ventilation Airway protection Renal dialysis Decreased GCS Multi-organ failure Uncorrectetd acidosis Hypothermia
Most common culprit/organism
Beta-haemolytic strep Ecoli Coliforms with urinary sepsis, PPROM and cerclage Staph aureus Strep pup genes/GAS Strep pneumonia MRSA Clostridium skepticism Morganella morganii
When to give IVIG
Severe invasive streptococcal or staphylococcal infection if other therapies have failed
*works by immunomodulatory effect, neutralizes superantigen effect of exotoxins, inhibits production of TNF and interleukins
Mother with Group A strep - what about baby
Treat prophylactically
Why avoid NSAIDs in GAS infection
Impede ability of polymorphs to fight infection
Red flag signs and symptoms
Pyrexia more than 38 Sustained tachy >90bpm Breathlessness (resp rate>20/min Abdominal pain Chest pain Diarrhea and/or vomiting Uterine or renal angle pain and tenderness Woman is generally unwell or seems unduly anxious or distressed
Suspicious of GAS
Early presentation of sepsis <12 hrs PP
Continous pain suggests NEC
Definition of maternal sepsis
A life-threatening condition defined as life threatening organ dysfunction caused by a deregulated host reponse to infection during pregnancy, childbirth, post-abortion, or pp period
Septic shock
Persistent hypoperfusion despite adequate fluid replacement therapy
Severe sepsis
Sepsis and sepsis-induced organ dysfunction or tissue hypoperfusion
