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Reproduction & Sexual Health > Maternal sepsis > Flashcards

Maternal sepsis Flashcards

1
Q

risk factors for maternal sepsis

A
  • 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

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2
Q

signs and symptoms of maternal sepsis

A
  • 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
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3
Q

Mortality rate of severe sepsis with acute organ dysfunction

A

20-40%

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4
Q

Mortality rate of septic shock

A

60%

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5
Q

sepsis in pregnancy - what temperatures do we get suspicious

A

> 38 or <36

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6
Q

sepsis in pregnancy - what heart rate do we get suspicious at?

A

> 100bpm

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7
Q

sepsis in pregnancy - at what resp rate do we get suspicious

A

> 20 per minute

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8
Q

sepsis in pregnancy - at what white cell count do we get suspicious?

A

> 16 or <6

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9
Q

what can happen to mental state in maternal sepsis?

A

confusion - delirium
agitated
hyperactivity

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10
Q

In an osce/on a ward with an unwell patient who you suspect could be septic - what is your approach?

A

ABCDE approach + Septic 6 bundle

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11
Q

Management of suspected sepsis - bloods

A

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

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12
Q

management of suspected sepsis - bacteriology screen for source of infection

A
  • paired blood cultures
  • high vaginal swab
  • throat swab (group A strep)
  • MSSU (midstream urine - UTI)
  • wound swab
  • sputum culture
  • viral throat swabs
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13
Q

what are we going to give for suspected sepsis?

A

IV co-amoxiclav within the “Golden Hour” +/- gentamicin depending on severity and clindamycin if sore throat (GAS)

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14
Q

what are we going to give for suspected sepsis if penicillin allergic?

A

Clindamycin + gentamicin

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15
Q

what are we going to give for suspected septic shock?

A

Tazocin , clindamycin + gentamicin if septic shock

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16
Q

is co-amoxiclav broad spectrum

A

yes

17
Q

sources of antenatal/intrapartum infection

A
  • Chorioamnionitis
  • Genitourinary
    Including HSV
  • Respiratory
    Influenza
    COVID
    CAP (community
    acquired pneumonia)
18
Q

postnatal sources of infection

A
  • Endometritis +/- RPOC
  • LUSCS wound/ episiotomy
  • Mastitis
  • Urinary tract (especially if catheterised)
  • CNS (if regional anaesthetic)
19
Q

what is chorioamnionitis?

A

Inflammation of the amniochorionic (fetal) membranes of the placenta, typically in response to microbial invasion

20
Q

what is the main cause of chorioamnionitis?

A

96% caused by ascending infection and usually polymicrobial from E Coli, Mycoplasma, Anaerobes and Group B Strep

21
Q

Signs and symptoms of chorioamnionitis

A

offensive PV loss,
fetal CTG concerns, maternal pyrexia and abdominal pain

22
Q

risk factors of maternal sepsis (i.e. factors that introduce microbes to uterine cavity)

A
  • invasive pre-natal diagnostics
  • prolonged rupture of membranes
  • prolonged labour
  • repeat digital examinations in context of ruptured membranes
  • nulliparity
  • meconium stained liquour
23
Q

in what cases would mother group B strep be higher risk of causing neonatal sepsis, pneumonia and meningitis

A

with pre-term labour or PROM

24
Q

Group B strep - what percentage of women have it in their genital tract?
Is this a risk to the baby?

A

20-40%

Most babies born to mothers colonised by GBS will have no problems

25
Q

what is endometritis

A

Infection of uterine lining following delivery or miscarriage

25
Q

endometritis presentation

A

Typically presents with abdominal pain, abnormal PV bleeding, offensive PV loss

26
Q

treatment of endometritis

A

Treatment with co-amoxiclav +/- surgical evacuation of uterus if significant RPOC

Co-trimoxazole +metronidazole if penicillin allergic

27
Q

mastitis - should women avoid feeding on that side

A

no

28
Q

mastitis management

A

First line management requires ensuring complete breast emptying by feeding +/- expressing. Warm compresses and NSAIDs
May require flucloxacillin if not improving or signs of sepsis
Clindamycin if penicillin allergic

29
Q

If mastitis has no response to Abx or suspicion of fluctuant swelling, what might it indicate? management?

A

breast abscess
Refer to breast team for USS +/- drainage

30
Q

what is epidural abscess

A

Rare cause of sepsis in those having had regional anaesthesia

31
Q

epidural abscess presentation

A

Can present with back pain or fever and potential for neurological deficit as it progresses

32
Q

epidural abscess management

A

Treatment with IV antibiotics +/- surgical decompression if no response or neurological concerns

Vancomycin, metronidazole and cefotaxime to cover MRSA, anaerobes and gram –ve bacteria

Choice between open surgery vs. CT guided aspiration to drain collection

Reproduction & Sexual Health (36 decks)

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