Obs: L&D - sepsis & amniotic fluid embolism Flashcards
what are the 2 commonest causes of sepsis in pregnancy?
chorioamnionitis
UTI
what is chorioamnionitis?
infection of the chorioamniotic membranes and amniotic fluid
caused by a large variety of bacteria
how are maternity patients monitored on antenatal and labour wards? (what scoring system)
MEOWS - maternity early obstetric warning system
name some none specific signs of sepsis
- Fever
- Tachycardia
- Raised respiratory rate (often an early sign)
- Reduced oxygen saturations
- Low blood pressure
- Altered consciousness
- Reduced urine output
- Raised white blood cells on a full blood count
- Evidence of fetal compromise on a CTG
what are some specific signs/symptoms that indicate chorioamnionitis?
- Abdominal pain
- Uterine tenderness
- Vaginal discharge
what are some signs/symptoms that may indicate UTI?
- Dysuria
- Urinary frequency
- Suprapubic pain or discomfort
- Renal angle pain (with pyelonephritis)
- Vomiting (with pyelonephritis)
name some blood tests to do in patients suspected of having sepsis?
- Full blood count to assess cell count including white cells and neutrophils
- U&Es to assess kidney function and for acute kidney injury
- LFTs to assess liver function and as a possible source of infection (e.g. acute cholecystitis)
- CRP to assess inflammation
- Clotting to assess for disseminated intravascular coagulopathy (DIC)
- Blood cultures to assess for bacteraemia
- Blood gas to assess lactate, pH and glucose
what investigations except blood tests can also be done when there is suspected maternal sepsis?
- Urine dipstick and culture
- High vaginal swab
- Throat swab
- Sputum culture
- Wound swab after procedures
- Lumbar puncture for meningitis or encephalitis
how is maternal sepsis managed?
senior obstetric/midwife input
early recognition and management - sepsis 6
continuous fetal and maternal monitoring
may require early delivery
antibiotics - follow local guidelines eg piperacillin and tazobactam plus gentamicin
what is an amniotic fluid embolism?
amniotic fluid passes into the mothers blood, usually occurs around labour and delivery
amniotic fluid contains fetal tissue, causing an immune reaction from the mother
the immune reaction to cells from the foetus leads to a systemic illness
more similarities to anaphylaxis than vte
mortality around 20%
what are the risk factors for amniotic fluid embolus
- Increasing maternal age
- Induction of labour
- Caesarean section
- Multiple pregnancy
amniotic fluid embolism can present similarly to sepsis, pulmonary embolism or anaphylaxis, what are some symptoms?
- Shortness of breath
- Hypoxia
- Hypotension
- Coagulopathy
- Haemorrhage
- Tachycardia
- Confusion
- Seizures
- Cardiac arrest
what is the management of an amniotic fluid embolus ?
supportive - no specific treatments
- A – Airway: Secure the airway
- B – Breathing: Provide oxygen for hypoxia
- C – Circulation: IV fluids to treat hypotension and blood transfusion in haemorrhage
- D – Disability: Treat seizures and consider other neurological deficits
- E – Exposure
CPR and immediate CS if cardiac arrest occurs
