Maternal Sepsis/Septic Shock

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CLINICAL DESCRIPTION

Sepsis is bacterial infection in pregnancy, childbirth, post-abortion, or postpartum period.

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Tachycardia (greater than120)
  • Hypotension (systolic blood pressure less than 90)
  • Respiratory distress (reduced oxygen saturations <94% or respiratory rate greater than 25)
  • Jaundice
  • Reduced urine output (less than 0.5ml/kg/hour)
  • Reduced level of consciousness
  • Features of malaria
  • Breast engorgement / abscess
  • Abdominal / uterine tenderness
  • Foul smelling vaginal discharge or lochia

Septic shock is a subset of sepsis in which underlying circulatory and cellular metabolism abnormalities are profound enough to substantially increase mortality.

INVESTIGATIONS

  • FBC, urine MC&S, blood culture, MPs, MRDT, HIV test, examine for neck stiffness, breast abscess, chest infection.
  • lumbar puncture or other swabs for microscopy e.g. high vaginal swab as appropriate. Consider if additional imaging is required, e.g. ultrasound, CXR

TREATMENT

PHARMACOLOGICAL

  • Airway, breathing, circulation (ABC)
    • O2 (can be discontinued if normal oxygen saturations)
    • Correct hypotension with IV crystalloid fluids (up to 30ml per kg over first 3 hours, given as 500ml rapid boluses).
  • Caution and senior advice are required in women with preeclampsia or severe anaemia.
    • If persistent hypotension or myocardial dysfunction, then consult anesthesia and physician. 
  • Broad spectrum intravenous antibiotics should be commenced urgently (Ceftriaxone+ Metronidazole or Benzyl Penicillin + Gentamicin + Metronidazole for 7 days if source is not known).
  • Remove the source. E.g., Incision and drainage, delivery, laparotomy, evacuation of retained products, as directed by infectious source.
  • Monitor response to treatment by charting the vital signs. Consider monitoring of the fetus or neonate if appropriate.
  • If not responding to initial treatment or septic shock, then transfer to HDU or ICU for intensive monitoring