Sepsis In Pregnancy

Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection

Aetiology

Risk factors

• Pre-natal invasive diagnostic procedures i.e. amniocentesis, CVS

• Cervical suture

• Prolonged rupture of membranes

• Operative delivery

• RPOC

• Diabetes

• Obesity

• Anaemia

• Immunosuppression

Sources of infection

• Chorioamnionitis

• GU including HSV

• Respiratory - influenza, COVID, CAP

• Endometritis +/- RPOC

• LUSCS wound/episiotomy

• Mastitis

• Urinary tract (especially if catheterised)

• CNS (if regional anaesthetic)

Pathophysiology

• Relative immunosuppression in pregnancy → maternal population at increased risk of pregnancy
• Shift from cell-mediated to humoral immunity

• Typically fit and healthy population - low index of suspicion and mask signs well

• Similarity between signs of sepsis and physiological changes in labour can delay recognition - tachycardia, raised WCC common

Clinical presentation

Signs and symptoms of maternal infection

• Offensive PV loss

• Sore throat

• Rash

• Abdominal pain

• Urinary frequency, dysuria

• Productive cough

• Would erythema, purulent discharge

• Breast erythema, tenderness

Signs of sepsis

• Raised respiratory rate (> 22)

• Tachycardia (HR > 100 bpm)

• High or low temp (> 38℃ or < 35℃)

• Hypotension (systolic BP < 90 mmHg)

• Low oxygen saturations (< 94% on air)

• Poor peripheral perfusion (cap refill > 2 secs)

• Skin clamminess

• Confusion/agitation

• Rash or mottled skin

Investigations

• Bloods - FBC, U+E, LFTs, coag., glucose, lactate, CRP

• Bacteriology screen for source of infection
• Paired blood cultures
• HVS
• Throat swab
• MSSU
• Wound swab
• Sputum culture
• Viral throat swabs

Management

• IV co-amoxiclav within the 'golden hour' +/- gentamicin depending on severity, + clindamycin if sore throat (GAS)
• Clindamycin and gentamycin if penicillin allergic

• Taxocin, clindamycin, and gentamicin if septic shock