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Puerperal Sepsis

From Mediwikis

This is sepsis occurring at any point after the birth until 6 weeks postnatally. In the UK this still causes around ten deaths per year, with significant morbidity.

Definitions:

  • Sepsis- Infection with systemic manifestations
  • Severe sepsis- Sepsis with organ dysfunction or tissue hypoperfusion
  • Septic Shock- Persistent hypoperfusion despite fluid replacement therapy

Risk Factors[1]

  • Obesity
  • Diabetes
  • Impaired immunity
  • Anaemia
  • Previous pelvic infection
  • Amniocentesis/ invasive procedures
  • Retained products of conception

Causative Organisms[1]

  • GAS- Streptococcus pyogenes
  • Escherichia coli
  • Staphylococcus aureus
  • Streptococcus pneumoniae

Site of infection

Note that a full clinical history should be undertaken in suspected sepsis to determine the site:

General Features[2]

  • Pyrexia
    • Particularly spiking temperatures
    • Normal temperature may be present (antipyretics, NSAIDs)
    • > 38 °C requires senior review
  • Hypothermia
  • Tachycardia
    • > 90 BPM requires senior review
  • Tachypnoea
  • Hypoxia
  • Hypotension
  • Oliguria
  • Reduced Consciousness

Red Flag signs and symptoms

  • Pyrexia > 38
  • Tachycardia > 90 BPM
  • Respiratory Rate > 20 or dyspnoea
  • Abdominal/ Chest pain
  • Diarrhoea/ vomiting
  • Uterine/ Renal tenderness
  • General unwellness

Investigation

Regular monitoring/observations:

  • Temperature
  • Pulse
  • Blood pressure
  • Respiratory Rate

Investigation appropriate to the suspected site of infection:

  • Send samples/ swabs appropriate to site of infection
  • Blood culture
  • FBC, U&E, CRP
  • Serum lactate (> 4 mmol/l means tissue hypoperfusion)
  • Relevant imaging
  • Nose swab for MRSA

Management

  • Urgent referral to hospital
  • Discuss with microbiology (including breastfeeding & antibiotics)
  • Locate likely source of infection
  • IV broad spectrum antibiotics (e.g. Piperacillin/Tazobactam)
  • IV immunoglobulin for severe streptococcal/ staphylococcal infection

References

  1. 1.0 1.1 Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives:reviewing maternal deaths to make motherhood safer: 2006–08.The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.BJOG 2011;118 Suppl 1:1–203
  2. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_64b.pdf