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
what is endometritis
Infection of uterine lining following delivery or miscarriage
endometritis presentation
Typically presents with abdominal pain, abnormal PV bleeding, offensive PV loss
treatment of endometritis
Treatment with co-amoxiclav +/- surgical evacuation of uterus if significant RPOC
Co-trimoxazole +metronidazole if penicillin allergic
mastitis - should women avoid feeding on that side
no
mastitis management
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
If mastitis has no response to Abx or suspicion of fluctuant swelling, what might it indicate? management?
breast abscess
Refer to breast team for USS +/- drainage
what is epidural abscess
Rare cause of sepsis in those having had regional anaesthesia
epidural abscess presentation
Can present with back pain or fever and potential for neurological deficit as it progresses
epidural abscess management
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
