Maternal Sepsis

Question 1

what can untreated maternal sepsis lead to?

Answer 1

septic shock

death

Question 2

what is the management for suspected sepsis?

Answer 2

ABCDE

sepsis 6

Question 3

what antibiotics should be given in the first hour if maternal sepsis is suspected?

Answer 3

IV co-amoxiclav

+/- gentamicin
+/- clindamycin if the patient has a sore throat

Question 4

what antibiotics should be given in the first hour if maternal sepsis is suspected in a penicillin allergic patient?

Answer 4

clindamycin + gentamici

Question 5

what antibiotics should be given for maternal septic shock?

Answer 5

tazocin, clindamycin and gentamicin

Question 6

what is chorioamnionitis?

Answer 6

inflammation of the amniochorionic membranes of the placenta

Question 7

what increases the risk of chorioamnionitis?

Answer 7

PROM
invasive pre-natal diagnostics
prolonged labour
nulliparity

Question 8

what usually causes chorioamnionitis?

Answer 8

ascending infection

Question 9

how does chorioamnionitis present?

Answer 9

offensive PV loss
foetal CTG concerns
maternal pyrexia
abdominal pain

Question 10

what is the possible complications if chorioamnionitis is not treated?

Answer 10

neonatal sepsis

Question 11

how is chorioamnionitis managed?

Answer 11

broad spectrum IV antibiotics

Question 12

how should delivery be approached in chorioamnionitis?

Answer 12

not in established labour = IOL or LUSCS

Question 13

what mode of contraception should be avoided following chorioamnionitis?

Answer 13

post partum intrauterine contraception

Question 14

what increases the risk of neonatal problems due to group B strep?

Answer 14

pre term labour

PROM

Question 15

what neonatal complications can be caused by group B strep?

Answer 15

neonatal sepsis
pneumonia
meningitis

Question 16

what intrapartum prophylaxis can be given for group B strep infection?

Answer 16

benzylpenicillin or clindamycin

Question 17

when would intrapartum prophylaxis be given for group B strep infection?

Answer 17

GBS detected antenatally
previous baby affected
delivery <37 weeks

Question 18

what is endometritis?

Answer 18

infection of the uterine lining

Question 19

what are some risk factors for endometritis in the postpartum period?

Answer 19

operative delivery
prolonged labour
retained products of conception (RPOC)

Question 20

how does endometritis present?

Answer 20

abdominal pain
abnormal PV bleeding
offensive PV loss

Question 21

how is endometritis managed?

Answer 21

co-amoxiclav

(co-trimoxazole + metronidazole if pen allergic)

may need surgical evacuation of the uterus for RPOC

Question 22

how does mastitis present?

Answer 22

unilateral, painful, inflamed breast in breastfeeding mothers

Question 23

what is the first line management of mastitis?

Answer 23

complete breast emptying by feeding/expressing
warm compresses
NSAIDs

Question 24

what management is done for mastitis that is not improving or has signs of sepsis?

Answer 24

flucloxacillin

clindamycin if pen allergic

Question 25

what should be suspected if mastitis doesnt respond to antibiotics?

Answer 25

breast abscess

also if there is fluctuant swelling

Question 26

how is a breast abscess managed?

Answer 26

refer to breast team for ultrasound and drainage

Question 27

how can an epidural abscess present?

Answer 27

back pain

fever

Question 28

what are the possible complications of epidural abscess?

Answer 28

neurological deficits

Question 29

how can epidural abscess be diagnosed?

Answer 29

MRI

Question 30

how is epidural abscess managed?

Answer 30

IV antibiotics = vancomycin, metronidazole, cefotaxime

surgical decompression