difference B/W sepsis followin pregnancy & in pregnancy

Question 1

Risk factors for maternal sepsis in pregnancy VS following pregnancy difference
as identified by confidential Enquiries into Maternal Deaths

Answer 1

Maternal sepsis in pregnancy
- History of group B streptococcal infection

Maternal sepsis following pregnancy

• Vaginal trauma, CS, wound haematoma
• Retained products of conception

Question 2

Clinical features suggestive of sepsis.

maternal sepsis in pregnancy VS following pregnancy Simmilarities

Answer 2

1 - Obesity
2 - Impaired glucose tolerance / diabetes
3 - Impaired immunity/ immunosuppressant medication
4 - Anaemia
5 - Vaginal discharge
6 - History of pelvic infection
7 - Amniocentesis and other invasive procedures
8 - Cervical cerclage
9 - Prolonged spontaneous rupture of membranes
10 - GAS infection in close contacts / family members
11 - Of black or other minority ethnic group origin

Question 3

Clinical features suggestive of sepsis.

maternal sepsis in pregnancy VS following pregnancy difference

Answer 3

Maternal sepsis in pregnancy
1 - Fever or rigors
3 - Rash (generalised streptococcal maculopapular rash or purpura fulminans)

Maternal sepsis following pregnancy
1 - Fever, rigors (persistent spiking temperature suggests abscess). Beware: normal temperature may be attributable to antipyretics or NSAIDs
3 - Breast engorgement / redness
4 - Rash (generalised maculopapular rash)
6 - Wound infection – spreading cellulitis or discharge
10 - Delay in uterine involution, heavy lochia
11 - General – non-specific signs as lethargy, reduced appetite.

Question 4

Clinical features suggestive of sepsis.
maternal sepsis in pregnancy VS following pregnancy
simmilarities

Answer 4

1 - Fever or rigors
2 - Diarrhoea or vomiting - may indicate exotoxin production (early toxic shock)
3 - Abdominal /pelvic pain and tenderness
4 - Offensive vaginal discharge (smelly suggests anaerobes; serosanguinous suggests streptococcal infection)
5 - Productive cough
6 - Urinary symptoms

Question 5

What should prompt recognition of sepsis in the pregnant woman?
‘Red flag’signs and symptoms (see below) should prompt urgent referral for hospital assessment and, if
woman appears seriously unwell, by emergency ambulance:

Answer 5

Maternal sepsis in pregnancy
1 - pyrexia, 
2 - hypothermia,
3 - tachycardia,
4 - tachypnoea, 
5 - hypoxia, 
6 - hypotension, 
7 - oliguria,
8 - impaired consciousness and
9 - failure to respond to treatment. 
- These signs, including pyrexia, may not always be present and not necessarily related to severity of sepsis.

Maternal sepsis following pregnancy
● pyrexia more than 38°C
● sustained tachycardia more than 90 beats/minute
● breathlessness (respiratory rate more than 20 breaths/minute; a serious symptom)
● abdominal or chest pain
● diarrhoea and/or vomiting
● uterine or renal angle pain and tenderness
● woman is generally unwell or seems unduly anxious or distressed.