Maternal Sepsis Flashcards
What are the ANTENATAL risk factors for maternal sepsis?
Obesity IGT / Diabetes Immunocomprised patients Anaemia Previous pelvic infection Minority ethnic group GAS infection in close contacts / family members (RCOG Guideline)
+ Developing world
What are the Intrapartum risk factors for developing maternal sepsis?
Abnormal vaginal discharge PROM Vaginal trauma / OASIS injury CS Wound haematoma Retained placenta
What is recommended for severe invasive streptococcal or staphylococcal infection if other therapies have failed?
IVIG
RCOG
How does IVIG help in staphylococcal / streptococcal infection
- immunomodulatory effect
- neutralises the superantigen effect of exotoxins
- inhibits production of tumour necrosis factor and interleukins
- main contra-indication to IVIG: congenital deficiency of IgA
- little evidence of benefit in Gram-negative (endotoxin related) species
Fever in the embryonic period of pregnancy may be associated with… (3)
- neural tube defects, oral clefts and congenital heart anomalies
Maternal death from sepsis is most commonly caused by what organism?
Group A streptococcal infection
What is the most common cause of maternal bacterial infection?
E. Coli
What is the definition of sepsis?
Life-threatening organ dysfunction caused by dysregulated host response to infection
What is the definition of septic shock?
Subset of sepsis in which profound circulatory, cellular and metabolic abnormalities substantially increase mortality
What are the elements involved in assessing organ dysfunction for the SOFA score?
- Coagulation
- Platelet count
- Liver function (Bilirubin)
- Cardiovascular system: MAP or presence and dose of inotropes and/or vasopressors
- Neurological system: GCS
- Renal function: Creatinine and urine output
- Respiration: partial pressure of arterial oxygen / fraction of inspired oxygen
Each parameter is scored from 0-4, using the worst available result for the day of assessment
Pregnant and postpartum women have a ___ fold increase in the incidence of invasive GAS infection compared with non-pregnant women
20-fold!
Reasons are unclear
In pregnancy, GAS can present with non-specific symptoms such as
- fever
- sore threat
- vomiting
- diarrhoea
How does Listeria present?
- fever
- flu-like symptoms
- headache
- vomiting
- diarrhoea
Non-infectious conditions that can mimic sepsis
Differential diagnosis
- Acute Pulmonary Embolus
- Amniotic fluid embolism
- Acute Fatty Liver of Pregnancy
- Adverse drug reactions / fever
- Acute liver failure - drug related, viral
- Acute adrenal insufficiency
- Acute pituitary insufficiency
- Autoimmune conditions
- Concealed haemorrhage
- Disseminated malignancy
- Pelvic thrombosis
- Transfusion reactions
In sepsis, mortality can increase by ___% for each hour’s delay in administering antibiotics
8%
What are the common organisms in puerperal sepsis?
GAS - Strep pyogenes E. Coli S. Aureus S. Pneumonia MRSA Clostridium septic I’m Morganella Morganii
What is the cardinal feature of Necrotising fasciitis?
Agonising pain
With pneumonia, what does severe haemoptysis and lower WBC count suggest?
PVL associated staphylococcal necrotising pneumonia
Panton-Valentine-Leukocidin
Mortality rate >70% in young, healthy people
A serum lactate >2 is associated with
Increased mortality in pregnancy
A serum lactate >4 is associated with
Tissue hypoperfusion
Fever in later pregnancy may be associated with
Fetal death
PTL
IUGR
Autism spectrum disorder and Developmental Delay
Note: the offspring of mothers who took anti-pyretic medications had a lower risk of Autism
What is the recommended antibiotic treatment for undifferentiated puerperal sepsis?
NZ: Cefuroxine + Metronidazole + Gentamicin
If risk of MRSA: Vancomycin
If risk of Multi-resistant organisms: Meropenem
If risk of GAS: Clindamycin
What is the recommended antibiotic treatment for Group A Sepsis?
Clindamycin 600mg IV q8h
+ consider Immunoglobulin
What type of medication is oseltamavir?
How does it work?
Neuraminidase inhibitor
Neuraminidase: promotion of release of viruses from infected particles
Neuraminidase inhibitor: Aggregation of the viral particles at the host cell surface, and a reduction in the amount of virus released to infect other cells
Reduces risk of death from Influenza and 84% reduction in ICU admissions
