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Laura MRCOG Part 2 > 12) Postnatal Care - Sepsis in pregnancy and postpartum > Flashcards

12) Postnatal Care - Sepsis in pregnancy and postpartum Flashcards

1
Q

Definition of sepsis

A

Infection + SIRS

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2
Q

Definition of severe sepsis

A

Sepsis + organ dysfunction/hypoperfusion

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3
Q

Mortality rate associated with severe sepsis

A

20-40%

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4
Q

Definition of septic shock

A

Hypoperfusion despite fluid resuscitation

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5
Q

Mortality rate associated with septic shock

A

60%

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6
Q

Risk factors for sepsis in pregnancy

A

Maternal:

  • Obesity
  • Diabetes
  • Immunosuppression
  • Anaemia
  • Vaginal discharge
  • Pelvic infection
  • GBS infection
  • GAS in close contacts
  • BAME

Obstetric:

  • Amniocentesis/other invasive procedures
  • Cervical cerclage
  • Prolonged SROM
Postnatal:
Vaginal trauma
Caesarean section
Wound haematoma
RPOC
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7
Q

When should Abx given?

A

Broad spectrum within 1 hour of recognition of severe sepsis.

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8
Q

What fluid resuscitation?

A

If hypotension/lactate >4 then an initial minimum 20mL/kg crystalloid.

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9
Q

Target MAP if using vasopressors

A

65mmHg

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10
Q

Target central venous pressure

A

8mmHg

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11
Q

Target central venous O2 sats and target mixed venous O2 sats

A

Central venous >70%

Mixed venous 65%

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12
Q

When should lactate be done?

A

Within 6 hours of suspected severe sepsis

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13
Q

When should blood cultures be done?

A

Prior to Abx (but don’t delay waiting for results)

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14
Q

What lactate value indicates tissue hypoperfusion?

A

4

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15
Q

Most common organisms in pregnant women dying of sepsis

A

E. Coil

Group A Strep

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16
Q

What organisms does co-amoxiclav not cover?

A

MRSA and pseudomonas

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17
Q

What organisms does metronidazole cover?

A

Anaerobes only

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18
Q

What does Clindamycin do?

A

Covers most Gram +vets and also anaerobes. Switches off exotoxins production.

19
Q

What does tazocin/meropenem not cover?

20
Q

What does gentamicin not cover?

A

Strep & Anaerobes.

21
Q

When can intravenous immunoglobulin be used?

A

Severe invasive strep or staph infection if other therapies have failed.

22
Q

What constitutes maternal pyrexia in labour?

A

Temp >38 or >37.5 on 2 occasions 2 hours apart

23
Q

When to do continuous CTG in labour?

A

Presence of maternal pyrexia or sepsis

24
Q

Notification/contacts for GAS

A

Invasive GAS notifiable. Household contacts should seek medical attention if symptoms develop - may warrant antibiotic prophylaxis. Healthcare workers exposed to respiratory secretions should be considered for Abx prophylaxis.

25
Q

What percentage of pharyngitis is caused by GAS?

26
Q

What are the Centor criteria for antibiotics in pharyngitis?

A

Fever
Tonsillitis exudate
No cough
Tender anterior cervical lymphadenopathy

27
Q

Red flag triggers for sepsis

A 
Pyrexia > 38
HR > 90
RR > 20
Abdo/chest pain
Diarrhoea/vomiting
Uterine/renal angle pain + tenderness
Generally unwell/unduly anxious/upset
28
Q

Diagnostic criteria for staphylococcal toxic shock

A

(Probable = 4/5 criteria met, Confirmed=all 5 criteria met)

  1. Fever >= 39.9
  2. Diffuse macular erythroderma
  3. Desquamation (10-14d after onset of illness)
  4. Hypotension (systolic < 90mmHg)
  5. Three or more of the following systems involved:
    - GI - vomiting/diarrhoea
    - Muscular - myalgia or elevated CK
    - Mucous membranes - vaginal/oropharyngeal/conjunctival hyperaemia
    - Renal - Cr 2 x ULN
    - Hepatic - Bilirubin 2 x ULN
    - Haematological - Platelets <100
    - CNS - disorientation or altered consciousness
29
Q

Criteria for diagnosis of streptococcal toxic shock syndrome

A

Probable - meets clinical case definition plus isolation from no-sterile site (throat, vagina, sputum)

Definite - meets clinical case definition plus isolation from sterile site (blood, CSF, peritoneal fluid, tissue biopsy)

  1. Hypotension
  2. Two or more of:
    - Renal impairment Cr >176
    - Coagulopathy platelets <100 or DIC
    - Liver (ALT/AST/Bili 2 x ULN)
    - ARDS
    - Generalised erythematous macular rash (10%) - may desquamate
    - Soft tissue necrosis (nec fas, myositis, gangrene)
30
Q

Guideline diagnostic criteria for sepsis: Temperature.

31
Q

Guideline diagnostic criteria for sepsis: HR

32
Q

Guideline diagnostic criteria for sepsis: RR

33
Q

Guideline diagnostic criteria for sepsis: Fluid balance

A

Positive fluid balance >20ml/kg over 24 hours

Oliguria <0.5ml/kg/hr for at least 2 hours

34
Q

Guideline diagnostic criteria for sepsis: Glucose

A

Plasma glucose >7.7 (in the absence of diabetes)

35
Q

Guideline diagnostic criteria for sepsis: WCC

A

> 12
<4
Normal but with >10% immature forms

36
Q

Guideline diagnostic criteria for sepsis: CRP

37
Q

Guideline diagnostic criteria for sepsis: Blood pressure

A

Systolic <90
MAP <70
Systolic pressure decrease >40

38
Q

Guideline diagnostic criteria for sepsis: Lactate

39
Q

Guideline diagnostic criteria for sepsis: Arterial oxygen

A

PaO2/FiO2<40kPa (severe if <33.3 in absence of pneumonia or 26.7 in presence of pneumonia)

40
Q

Guideline diagnostic criteria for sepsis: Creatinine

A

Rise of >44.2

overall >176 (Severe)

41
Q

Guideline diagnostic criteria for sepsis: Coagulation

A

INR >1.5, APTT >60s

42
Q

Guideline diagnostic criteria for sepsis: Platelets

43
Q

Guideline diagnostic criteria for sepsis: Bilirubin

44
Q

Guideline diagnostic criteria for sepsis: Bowels

Laura MRCOG Part 2 (56 decks)

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