Sepsis in Pregnancy Flashcards
What is severe sepsis?
When sepsis results in organ dysfunction, such as hypoxia, oliguria or raised lactate.
What is septic shock?
When arterial blood pressure drops and results in organ hypo-perfusion.
What are the 2 key causes of sepsis in pregnancy?
1) Chorioamnionitis
2) Urinary tract infections
What is chorioamnionitis?
An ascending infection of the chorioamniotic membranes and amniotic fluid.
It is a leading cause of maternal sepsis and a notable cause of maternal death (along with urinary tract infections).
What is the major risk factor for chorioamnionitis?
Preterm premature rupture of membranes (however, it can still occur when the membranes are still intact).
How can PPROM lead to chorioamnionitis?
Premature rupture of membranes exposes the normally sterile environment of the uterus to potential pathogens.
Which organisms can cause chorioamniotitis?
Chorioamnionitis can be caused by a large variety of bacteria, including gram-positive bacteria, gram-negative bacteria and anaerobes.
What is the mainstay of initial treatment of chorioamnionitis?
1) prompt delivery of foetus (via c-section if necessary)
2) administration of IV Abx
All patients admitted to maternity inpatient units, such as at the antenatal ward and labour ward, will have monitoring on what chart?
MEOWS chart –> maternity early obstetric warning system.
This includes monitoring their physical observations to identify signs of sepsis.
What are some non-specific signs of sepsis?
1) fever
2) tachycardia
3) raised RR (often an early sign)
4) reduced O2 sats
5) low BP
6) altered consciousness
7) reduced urine output
8) raised WCC on a FBC
9) evidence of fetal compromise on a CTG
What are some additional signs and symptoms related to chorioamnionitis?
1) abdo pain
2) uterine tenderness
3) vaginal discharge
What are some additional signs and symptoms related to a urinary tract infection in pregnancy?
1) dysuria
2) urinary frequency
3) suprapubic pain or discomfort
4) renal angle pain: with pyelonephritis
5) vomiting: pyelonephritis
Investigations in patients with suspected sepsis?
1) FBC to assess cell count including white cells and neutrophils
2) U&Es to assess kidney function and for acute kidney injury
3) LFTs to assess liver function and as a possible source of infection (e.g. acute cholecystitis)
4) CRP to assess inflammation
5) Clotting to assess for disseminated intravascular coagulopathy (DIC)
6) Blood cultures to assess for bacteraemia
7) Blood gas to assess lactate, pH and glucose
What are some additional investigations that can be helpful based on the suspected source of infection in sepsis?
1) Urine dipstick and culture
2) High vaginal swab
3) Throat swab
4) Sputum culture
5) Wound swab after procedures
6) Lumbar puncture for meningitis or encephalitis
Management of sepsis in pregnancy?
1) sepsis 6
2) continuous maternal and fetal monitoring
3) early delivery may be needed (may need an emergency c-section)
4) broad spectrum Abx
- e.g. piperacillin and tazobactam (tazocin) plus gentamicin, or;
- amoxicillin, clindamycin and gentamicin.
What type of anaesthesia is generally indicated in delivery in pregnant women with sepsis?
General anaesthesia is usually required for women with sepsis.
What type of anaesthesia is avoided in pregnant women with sepsis?
Spinal anaesthesia.
Why is spinal anaesthetic contraindicated in septic patients?
1) Septic vasodilated hypotensive patients may not tolerate the sympathetic block associated with spinal anaesthesia.
2) There may be associated coagulopathy or thrombocytopaenia.
What is neonatal sepsis?
Occurs when a a serious bacterial or viral infection in the blood affects babies within the first 28 days of life.
How can neonatal sepsis be categorised?
1) Early onset sepsis (EOS)
2) Late onset sepsis (LOS)
When does early onset neonatal sepsis (EOS) occur?
Within 72 hours of birth
