TOG vol 22-1 Flashcards
Prevalence of puerperal sepsis worldwide (WHO)
after live births
4.4%
with a greater burden in LMICs (7%) than in HICs (1–2%)
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
Risk of maternal mortality from sepsis
(WHO, high-income countries)
8%
4th leading direct cause of death
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
Risks of sepsis to fetus
miscarriage
stillbirth
Preterm labour
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
Percent of stillbirth cases related to infection/sepsis
10-25% HIC
upto 50% LIC
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
pathogen most often implicated in maternal death
GAS
notifiable disease
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
criteria for septic shock
Hint: there are 3!
- sepsis (ie. organ dysfunction + infection)
- vasopressor requirements to maintain MAP>65
- lactate >2 mmol/L
NB: in absence of hypovolemia
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
risk of sepsis in operative vaginal birth
**16% **
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
blood cultures positive only in how many percent of cases?
(in maternal sepsis)
30-40%
Greer, O, Shah, NM, Johnson, MR. Maternal sepsis update: current management and controversies. The Obstetrician & Gynaecologist 2020; 22: 45– 55. https://doi.org/10.1111/tog.12623
incidence of stroke in pregnancy
30/100 000 pregnancies
(3x more common in pregnant than non-pregnant)
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624
% of strokes occuring peripartum or in first 6 weeks
90%
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624
independent risk factors for stroke
Hint: there are 5!
age >35 PET/eclampsia Migraines GDM PIH
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624
case fatality of strokes
(overall, hemorrhagic, ischemic)
overall 8.8-20%
hemorrhagic 13.9%
ischemic 3.4%
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624
single greatest cause of death from stroke
intracranial hemorrhage
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624
% of CVT with typical stroke symptoms
40%
may be associated with headache, drowsiness, or confusion
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624
% of all strokes comprised by recurrent strokes
25-30%
Khalid, A, Hadbavna, A, Williams, D, Byrne, B. A review of stroke in pregnancy: incidence, investigations and management. The Obstetrician & Gynaecologist 2020; 22: 21– 33. https://doi.org/10.1111/tog.12624