Sepsis in pregnancy

Question 1

What is sepsis?

Answer 1

Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection

Question 2

Risk factors for maternal sepsis?

Answer 2

Pre-natal invasive diagnostic procedures i.e. amniocentesis, CVS

Diabetes

Obesity

Anaemia

RPOC (retained products of conception)

Immunosuppression

Operative delivery

Question 3

Antenatal/intrapartum sources of infection?

Answer 3

• Chorioamnionitis
• GU (genitourinary) including HSV
• Respiratory - influenza, COVID etc.

Question 4

Postnatal sources of infection?

Answer 4

• Endometriosis +/- RPOC
• Mastitis (inflammation of mammary gland)
• Urinary tract (especially if catheterised)
• CNS (if regional anaesthetic)

Question 5

Signs and symptoms of maternal infection?

Answer 5

• Offensive PV loss (bleeding per vaginum) - usually scanty, brownish and altered.
• Sore throat
• Rash
• Abdominal pain
• Urinary frequency, dyuria (painful urination).
• Productive cough

Question 6

Signs of sepsis?

Answer 6

• Raised respiratory rate (>22)
• Tachycardia (HR > 100 bpm)
• High or low temp (>38 degrees celsius or <35 degrees celsius).
• Skin clamminess
• Confusion/agitation
• Poor peripheral perfusion (cap refill > 2 secs)
• Hypotension (systolic BP < 90 mmHg)

Question 7

What bloods can be done for investigation of maternal sepsis?

Answer 7

FBC, U+E, LFT’s, glucose, lactate, CRP, coagulation tests

Question 8

What bacteriology screening is done for infection sources?

Answer 8

• Paired blood cultures
• HSV
• Throat swab
• Midstream specimen sample of urine (MSSU)
• Wound swab
• Sputum culture
• Viral throat swab

Question 9

Management of maternal sepsis?

Answer 9

IV co-amoxiclav within “golden hour” +/- gentamicin depending on severity + clindamycin if sore throat

Question 10

Antibiotics used if penicillin allergic?

Answer 10

Clindamycin and gentamicin if penicillin allergic

Question 11

Antibiotics used for septic shock?

Answer 11

Toxacin, clindamycin and gentamicin

Question 12

What is septic shock?

Answer 12

Septic shock describes sepsis complicated by organ failure and blood pressure that remains low despite treatment with fluids.

Question 13

What is the “golden hour” for sepsis?

Answer 13

treat people with life-threatening sepsis within one hour

Question 14

What is severe sepsis?

Answer 14

When sepsis results in organ dysfunction, such as hypoxia, oliguria or raised lactate.

Septic shock is defined when arterial blood pressure drops and results in organ hypo-perfusion.

Question 15

What are 2 key causes of sepsis in pregnancy?

Answer 15

Chorioamnionitis

Urinary tract infections

Question 16

What is chorioamnionitis?

Answer 16

An infection of the chorioamniotic membranes and amniotic fluid.

Chorioamnionitis is a leading cause of maternal sepsis and a notable cause of maternal death (along with urinary tract infections). It usually occurs in later pregnancy and during labour.

Question 17

Chorioamnionitis is caused by a specific bacteria. true/false?

Answer 17

False

Chorioamnionitis can be caused by a large variety of bacteria, including gram-positive bacteria, gram-negative bacteria and anaerobes.

Question 18

Additional chorioamnionitis related features of sepsis?

Answer 18

Abdominal pain
Uterine tenderness
Vaginal discharge

Question 19

Additional UTI related features of sepsis?

Answer 19

Dysuria
Urinary frequency
Suprapubic pain or discomfort
Renal angle pain (with pyelonephritis)
Vomiting (with pyelonephritis)

Question 20

What is the sepsis 6?

Answer 20

A checklist of 6 components given within an hour of the patient being shown to have sepsis in order to reduce probability of mortality.

Question 21

Components of the sepsis 6?

Answer 21

Three tests:

Blood lactate level
Blood cultures
Urine output

Three treatments:

Oxygen to maintain oxygen saturations 94-98%
Empirical broad-spectrum antibiotics
IV fluids