Maternal SEPSIS/SEPTIC Shock

Clinical Description

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

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

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