Bacterial Sepsis in Pregnancy

Question 1

What is the mortality of severe sepsis with acute organ dysfunction?

Answer 1

20-40%

Question 2

What is the mortality of severe sepsis with acute organ dysfunction + shock?

Answer 2

60%

Question 3

What is the definition of septic shock?

Answer 3

Hypoperfusion despite fluid replacement

Question 4

When giving IV fluids what should be the aim
MAP
CVP
Central venous O2

Answer 4

MAP >65mmHg
CVP >8mmHg
Central venous O2 >70%

If not maintaining - inotropes

Question 5

A serum lactate of which level indicates tissue hypo perfusion?

Answer 5

> 4

Question 6

Which are the most common organisms identified in pregnant women dying from sepsis?

Answer 6

Lancefield group A beta-haemolytic Streptococcus

E.Coli

Question 7

When should transfer to ITU be considered?

Answer 7

Cardiovascular:
Hypotension or raised serum lactate persisting despite fluid resuscitation, suggesting the need for inotrope support

Resp:
Pulmonary oedema Mechanical ventilation Airway protection

Renal:
Renal dialysis

Neuro:
Significantly decreased conscious level

Other
Multi-organ failure Uncorrected acidosis Hypothermia

Question 8

Limitations of Co-amoxiclav?

Answer 8

No MRSA or pseudomonas cover
Risk of NEC in neonates

Question 9

Limitations metronidazole

Answer 9

Only covers anaerobes

Question 10

What bacteria does clindamycin treat?

Answer 10

Covers most strep and staphylococci including MRSA, swithes off exotoxin production decreasing mortality.

Not renally excreted

Question 11

Tazosin and carbapenems?

Answer 11

Covers all except MRSA, renal sparing

Question 12

Limitations with gentamicin

Answer 12

Can cause renal impairment, levels need to be monitored

Question 13

For which infections can IVIG be considered?

Answer 13

severe invasive streptococcal or staphylococcal infection if other therapies have failed.

Question 14

If delivered required during to instability of mother during sepsis, what anaesthesia should be offered

Answer 14

GA cannot do regional anaesthesia w

Question 15

If mother develops Invasive Strep A, what steps should be talem

Answer 15

1) Inform neonates, baby will required prophylactic Abx
2) Close contacts should be warned and offered prophylactic Abx
3) Healthcare workers who had closed contact should be offered prophylactic Abx
4) Notafiable disease, inform infection control and consultant
5) Mother should be isolated