Maternal Sepsis Flashcards
What is sepsis?
- condition where body launches large immune response to infection causing systemic inflammation and affecting organ functioning
- significant cause of maternal death
What is sever sepsis?
-when sepsis reults in organ dysfunction such as hypoxoa, oliguria or raised lactate
What is septic shock?
when arterial blood pressure drops and results in organ hypo-perfusion
What are the 2 key causes of sepsis in pregnancy?
- chorioamnionitis
- UTI
What is chorioamnionitis?
- an infection of the chorioamniotic membranes and amniotic fluid
- leading cause of maternal sepsis
- usually occurs in later pregnancy and during labour
What bacteria can cause chorioamnionitis?
large variety of bacteria including:
- gram-positive bacteria
- gram-negative bacteria
- anaerobes
What are non-specific signs of sepisis?
- 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 additional signs and symptoms are related to chorioamnionitis?
- abdo pain
- uterine tenderness
- vaginal discharge
What additional signs and symptoms are related to UTIs?
- Dysuria
- Urinary frequency
- Suprapubic pain or discomfort
- Renal angle pain (with pyelonephritis)
- Vomiting (with pyelonephritis)
What are the blood tests that would be arranged for pts with suspected sepsis?
- FBC
- U&Es
- LFTs
- CRP
- clotting
- blood cultures
- blood gas to assess lactate, pH and glucose
What additional investigations can be helpful for sepsis?
- urine dipstick and culture
- high vaginal swab
- throat swab
- sputum culture
- wound swab after procedures
- lumbar puncture for meningitis or encephalitis
What does management of chorioamnionitis and sepsis involve?
- septic six
- continuous maternal and fetal monitoring
- early delivery may be needed with emergency c section indicated when fetal distress
- for c-section general anaesthesia is required for women with sepsis
- heavy-hitting antibiotics required
What antibiotics might be used for maternal sepsis?
varies between trusts
-piperacillin and tazobactam (tazocin) plus gentamicin or amoxicillin, clindamycin and gentamicin
What is the septic six?
involves early management and recognition of sepsis
Three tests:
- blood lactate level
- blood cultures
- urine output
Three treatments:
- oxygen to maintain sats 94-98%
- empirical broad-spectrum antibiotics
- IV fluids
