Post-Partum Sepsis Flashcards
List the common sites of infection:
Endometritis Pelvic abscess Perineal Wound Infection Mastitis Epidural site infection Caesarean wound infection UTI Pneumonia (Chest infection)
Define Sepsis
Generalised infection + systemic manifestations of infection
define Severe sepsis
Sepsis + organ dysfunction + tissue hypoperfusion
Lactate > 2mmol/l
Septic shock
Severe sepsis + persistence of tissue hypoperfusion depsite fluid replacement
Lactate > 4mmol/l
Incidience of pregnancies admitted for infection in ireland
12% (2015 stats)
Common organisms
Group A Strep (pneumoniae)
E Coli
Staph Aureus
What are the cut-offs for vitals in the mother
HR > 100 RR > 20 BP < 100/50 Lactate > 2mmol/l O2 Sats < 94%
What abx to give in sepsis
Co-amoxiclav + Clindamycin + Gentamicin
If MRSA +ve –> Vancomycin
Why avoid NSAIDs
- Reduce the Macrophage ability to fight Grp A Strep
2. Reduce renal perfusion
How to treat endometritis + RCOP
Speculum + US. Look for vaginal loss + os open
Abx for 24 hours:
- Co-amoxiclav + Gentamicin
Then uterine evacuation
Individual Risk factors for maternal sepsis
Individual:
- BMI > 30
- Black or asian or minority groups
- Systemic disorders: diabetes, anaemia
- Impaired immunity
- Poor nutrition
- Smoker
- Poor hygiene
Antenatal Risk factors for sepsis
Antenatal:
- Delay or no prophylatic abx
- Prolonged rupture of membranes ( > 12 hours)
Post-partum risk factors for sepsis
Invasive procedures - Caesarean
Genital infection / Discharge
Group A Strep infection in close contacts
Complications of birth:
- perineal tear
- uterine perforation
- Wound haematoma
- retained product of conception
Incidence of post partum UTI & treatment
5%. Abx: - Co-amoxiclav - Cephalosphorin - Gentamicin (for rare cases)
What abx to avoid in UTI for breast feeding mothers
Nitrofurantoin + Sulphonamides
