Maternal sepsis Flashcards
risk factors for maternal sepsis
- Pre-natal invasive diagnostic procedures (i.e. amniocentesis, CVS)
- Cervical suture
- Prolonged rupture of membranes
- Operative delivery
- RPOC (retained products of conception) - miscarriage etc.
Diabetes
Obesity
Anaemia
Immunosuppression
signs and symptoms of maternal sepsis
- Offensive PV loss
- Sore throat
- Rash
- Abdominal pain
- Urinary frequency, dysuria
- Productive cough
- Wound erythema (e.g. c section, episiotomy, purulent discharge
- Breast erythema (mastitis), tenderness
Mortality rate of severe sepsis with acute organ dysfunction
20-40%
Mortality rate of septic shock
60%
sepsis in pregnancy - what temperatures do we get suspicious
> 38 or <36
sepsis in pregnancy - what heart rate do we get suspicious at?
> 100bpm
sepsis in pregnancy - at what resp rate do we get suspicious
> 20 per minute
sepsis in pregnancy - at what white cell count do we get suspicious?
> 16 or <6
what can happen to mental state in maternal sepsis?
confusion - delirium
agitated
hyperactivity
In an osce/on a ward with an unwell patient who you suspect could be septic - what is your approach?
ABCDE approach + Septic 6 bundle
Management of suspected sepsis - bloods
FBC - see if they have a raised white cell count
U&Es - see if they have signs of renal hyperperfusion, AKI
LFTs - might have hepatic dysfunction, more suspicious of a coagulopathy
Glucose - raised in infection, important in diabetic patients
CRP - marker of infection
management of suspected sepsis - bacteriology screen for source of infection
- paired blood cultures
- high vaginal swab
- throat swab (group A strep)
- MSSU (midstream urine - UTI)
- wound swab
- sputum culture
- viral throat swabs
what are we going to give for suspected sepsis?
IV co-amoxiclav within the “Golden Hour” +/- gentamicin depending on severity and clindamycin if sore throat (GAS)
what are we going to give for suspected sepsis if penicillin allergic?
Clindamycin + gentamicin
what are we going to give for suspected septic shock?
Tazocin , clindamycin + gentamicin if septic shock
is co-amoxiclav broad spectrum
yes
sources of antenatal/intrapartum infection
- Chorioamnionitis
- Genitourinary
Including HSV - Respiratory
Influenza
COVID
CAP (community
acquired pneumonia)
postnatal sources of infection
- Endometritis +/- RPOC
- LUSCS wound/ episiotomy
- Mastitis
- Urinary tract (especially if catheterised)
- CNS (if regional anaesthetic)
what is chorioamnionitis?
Inflammation of the amniochorionic (fetal) membranes of the placenta, typically in response to microbial invasion
what is the main cause of chorioamnionitis?
96% caused by ascending infection and usually polymicrobial from E Coli, Mycoplasma, Anaerobes and Group B Strep
Signs and symptoms of chorioamnionitis
offensive PV loss,
fetal CTG concerns, maternal pyrexia and abdominal pain
risk factors of maternal sepsis (i.e. factors that introduce microbes to uterine cavity)
- invasive pre-natal diagnostics
- prolonged rupture of membranes
- prolonged labour
- repeat digital examinations in context of ruptured membranes
- nulliparity
- meconium stained liquour
in what cases would mother group B strep be higher risk of causing neonatal sepsis, pneumonia and meningitis
with pre-term labour or PROM
Group B strep - what percentage of women have it in their genital tract?
Is this a risk to the baby?
20-40%
Most babies born to mothers colonised by GBS will have no problems
