9.15 Maternal Sepsis Flashcards
What are two key causes of sepsis in pregnancy?
- chorioamnionitis
- UTI
What bacteria can cause chorioamnionitis?
wide range:
- gram+ve and gram-ve
- and anaerobes
How do you monitor maternity inpatients for sepsis?
MEOWS chart (maternity early obstetric warning system)
List various non-specific sign 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 signs and symptoms might suggest chorioamnionitis?
Abdominal pain
Uterine tenderness
Vaginal discharge
What signs and symptoms might suggest UTI?
Dysuria Urinary frequency Suprapubic pain or discomfort Renal angle pain (with pyelonephritis) Vomiting (with pyelonephritis)
What blood test for suspected maternal 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 Ix will you do to find the source of infection / isolate the bacteria?
Urine dipstick and culture High vaginal swab Throat swab Sputum culture Wound swab after procedures Lumbar puncture for meningitis or encephalitis
What Abx are used in maternal sepsis?
eg:
piperacillin and tazobactam (tazocin) 4.5g/8hr possibly plus gentamicin
What are you sepsis 6?
Take 3:
- Blood lactate level
- Blood cultures
- Urine output
Give 3:
- Oxygen to maintain oxygen saturations 94-98%
- Empirical broad-spectrum antibiotics
- IV fluids
What else is done in management of maternal sepsis?
- continuous maternal and fetal monitoring
- emergency c-section if fetal distress
- GA not spinal
