Maternal sepsis: a comprehensive review from definition to treatment

Abstract

Maternal mortality is a worldwide alarming concern, and sepsis is the third most frequent cause for its occurrence. Pregnancy and the postpartum period are an intrinsically vulnerable period during women's life, which may make the mothers more susceptible to develop sepsis, due to the physiological and immunological changes that regulate host capacity to counteract pathogens infection, such as bacteria, viruses, fungi, and protozoa. The physiological adaptations of pregnancy could additionally mask signs and symptoms of infection and limit the sensitivity and specificity of the available scores. On this basis, the obstetric-modified quick SOFA and the Modified Early Warning System were proposed to overcome these issues. Early recognition and treatment are vital to prevent mortality. Nevertheless, the evidence guiding the current management of maternal sepsis are derived from the general population and do not take into account the physiological changes of pregnancy. In pregnant women early fluid resuscitation should be carefully addressed, and the management of the source of infection may require expedite delivery, making the management of sepsis particularly challenging during gestation. Further studies are needed to establish pregnancy-related diagnostic criteria and therapeutic protocols for sepsis and septic shock in the obstetrical population.

Bladder invasion of placenta percreta: review of literature and our experience

“…When fluid resuscitation is needed, we must consider that women in the immediate postpartum period have increased blood volume and systemic vasodilatation while colloid oncotic pressure is lower. This can lead to third space expansion, pulmonary oedema, and left ventricular diastolic dysfunction, which is why after initial fluids administration, further eventual fluid therapy should be guided by dynamic measures of preload [25,26]. The ideal timing of delivery for these patients has yet to be determined.…”