Maternal Sepsis

Question 1

What is sepsis?

Answer 1

• condition where body launches large immune response to infection causing systemic inflammation and affecting organ functioning
• significant cause of maternal death

Question 2

What is sever sepsis?

Answer 2

-when sepsis reults in organ dysfunction such as hypoxoa, oliguria or raised lactate

Question 3

What is septic shock?

Answer 3

when arterial blood pressure drops and results in organ hypo-perfusion

Question 4

What are the 2 key causes of sepsis in pregnancy?

Answer 4

• chorioamnionitis

- UTI

Question 5

What is chorioamnionitis?

Answer 5

• an infection of the chorioamniotic membranes and amniotic fluid
• leading cause of maternal sepsis
• usually occurs in later pregnancy and during labour

Question 6

What bacteria can cause chorioamnionitis?

Answer 6

large variety of bacteria including:

• gram-positive bacteria
• gram-negative bacteria
• anaerobes

Question 7

What are non-specific signs of sepisis?

Answer 7

• 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

Question 8

What additional signs and symptoms are related to chorioamnionitis?

Answer 8

• abdo pain
• uterine tenderness
• vaginal discharge

Question 9

What additional signs and symptoms are related to UTIs?

Answer 9

• Dysuria
• Urinary frequency
• Suprapubic pain or discomfort
• Renal angle pain (with pyelonephritis)
• Vomiting (with pyelonephritis)

Question 10

What are the blood tests that would be arranged for pts with suspected sepsis?

Answer 10

• FBC
• U&Es
• LFTs
• CRP
• clotting
• blood cultures
• blood gas to assess lactate, pH and glucose

Question 11

What additional investigations can be helpful for sepsis?

Answer 11

• urine dipstick and culture
• high vaginal swab
• throat swab
• sputum culture
• wound swab after procedures
• lumbar puncture for meningitis or encephalitis

Question 12

What does management of chorioamnionitis and sepsis involve?

Answer 12

• 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

Question 13

What antibiotics might be used for maternal sepsis?

Answer 13

varies between trusts

-piperacillin and tazobactam (tazocin) plus gentamicin or amoxicillin, clindamycin and gentamicin

Question 14

What is the septic six?

Answer 14

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

Question 15

How would a patient with PPROM but no signs of infection be managed?

Answer 15

1. Monitor for signs of infection
2. Offer oral erythromycin 250 mg QDS for a maximum of 10 days or until the patient is in established labour
3. Do NOT use tocolysis (increases risk of infection)
4. Decision to deliver depends on balance of risk of prematurity and risk of maternal/foetal infection if delivery is delayed