Sepsis in Pregnancy ****

Question 1

Define sepsis?

Define septic shock?

Answer 1

Infection plus systemic manifestations of infection

Persistent tissue hypoperfusion despite an adequate fluid replacement

Question 2

Risk factors

Answer 2

Obesity
DM
Pelvic infection
Hx of GBS

Prolonged rupture of membranes

Question 3

Clinical features - list some

Answer 3

Fever
Rigours
D&V
Rash
Abdo/pelvic pain 
Vaginal discharge
Productive cough 
Urinary symptoms

Question 4

Diagnostic criteria:

• Temp - 2
• HR
• RR
• BP
• Glucose
• Other - 2

Answer 4

> 38 or <36

Tachycardia >100

> 20

<90 systolic

> 7.7 mmol/L

Impaired mental state and oedema

Question 5

Diagnostic criteria:

• Inflammatory markers - 2
• Tissue perfusion - 2

Organ dysfunction - what would suggest that there is:

• AKI - 2
• Liver dysfunction - 2

Arterial hypoxaemia may be present on an ABG. What is it?

Answer 5

Raised WCC
Raised leukocytes 
----
Raises lactate 
Capillary refill 
----

Oliguria
Raised creatinine

Raised INR
Thrombocytopenia

Abnormally low level of oxygen in the arterial blood.

Question 6

Investigations:

Bedside:

• Where may cultures be done?
• What is done if there is respiratory distress?

Bloods that need to be done - 7

Answer 6

Throat etc.
ABG

Cultures 
FBC 
U&Es
LFTs
CRP/ESR
Clotting 
Lactate

Question 7

Treatment:

Sepsis 6 - what is 3 in?

What can be given if there is no response to fluids?

What antibiotics are given within first hour?

What can be given if it is severe and all other regimes have been tried?

What needs to be done if it becomes to severe?

Answer 7

IV broad spec ABs
Fluids
Oxygen

Vasopressors

Piperacciliin-tazobactum

Immunoglobulins

Intensive care

Question 8

What fetal monitoring is used?

What type of delivery is done?

What tests should be done for the baby once born?

Answer 8

CTG

CS with GENERAL anaesthesia - not spinal

ABG and VBG