Maternal sepsis

Question 1

What is sepsis?
Severe sepsis?
Septic shock?

Answer 1

Sepsis is a condition where the body launches a large immune response to an infection, causing systemic inflammation and affecting the functioning of the organs of the body. It is a significant cause of maternal death.

Severe sepsis is when sepsis results in organ dysfunction, such as hypoxia, oliguria or raised lactate.

Septic shock is defined when arterial blood pressure drops and results in organ hypo-perfusion.

Question 2

Two key causes of sepsis in pregnancy?

Answer 2

Two key causes of sepsis in pregnancy are:

Chorioamnionitis
Urinary tract infections

Question 3

What is chorioamnionitis?

Caused by?

Answer 3

Chorioamnionitis is an infection of the chorioamniotic membranes and amniotic fluid. Chorioamnionitis is a leading cause of maternal sepsis and a notable cause of maternal death (along with urinary tract infections). It usually occurs in later pregnancy and during labour.

Chorioamnionitis can be caused by a large variety of bacteria, including gram-positive bacteria, gram-negative bacteria and anaerobes.

Question 4

Signs of sepsis?
Chorioamninitis?
UTI?

Answer 4

The non-specific signs of sepsis include:

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

Additional signs and symptoms related to chorioamnionitis include:
Abdominal pain
Uterine tenderness
Vaginal discharge

Additional signs and symptoms related to a urinary tract infection include:
Dysuria
Urinary frequency
Suprapubic pain or discomfort
Renal angle pain (with pyelonephritis)
Vomiting (with pyelonephritis)

Question 5

Investigations for maternal sepsis?

Answer 5

Arrange blood tests for patients with suspected 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

Additional investigations can be helpful based on the suspected source of infection:

Urine dipstick and culture
High vaginal swab
Throat swab
Sputum culture
Wound swab after procedures
Lumbar puncture for meningitis or encephalitis

Question 6

Management of maternal sepsis?

Answer 6

Continuous maternal and fetal monitoring is required. Depending on the condition of the mother and fetus, early delivery may be needed. Emergency caesarean section may be indicated when there is fetal distress, guided by a senior obstetrician. General anaesthesia is usually required for women with sepsis, as spinal anaesthesia is avoided.

Three tests:

Blood lactate level
Blood cultures
Urine output

Three treatments:

Oxygen to maintain oxygen saturations 94-98%
Empirical broad-spectrum antibiotics
IV fluids