New Concept and Management for Sepsis in Pregnancy and the Puerperium

Abstract

Sepsis, which is life-threatening organ dysfunction resulting from a dysregulated host response to infection, remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leading causes of maternal morbidity and mortality. The obstetric causes include uterine infection, septic abortion, and wound infection. The non-obstetric causes include pyelonephritis and pneumonia. Maternal sepsis may also be from obstetrical critical illness, such as obstetric severe hemorrhage, obstetric (amniotic fluid/pulmonary) embolism, acute fatty liver of pregnancy, and congestive heart failure, cardiopulmonary arrest, and major trauma. The most commonly reported pathogens in maternal sepsis include Escherichia coli, Streptococcus, Staphylococcus, and other gram-negative bacteria. Maternal sepsis may cause intrauterine infection, which results in (1) preterm premature rupture of membranes or preterm labor or birth, (2) cerebral white matter damage or cerebral palsy or neurodevelopmental delay, (3) stillbirth, (4) early- or late-onset sepsis, and (5) perinatal death. The “Hour-1 bundle” should be initiated within the first hour of the recognition of sepsis. The use of early, appropriate antibiotics is crucial in the management of maternal sepsis. Fetal status should be monitored. Appropriate and early source control should be provided. The decision for delivery is often quite complex and should be individualized to each patient's clinical scenario while taking into consideration the suspected source of infection, maternal status, fetal well-being, and gestational age. Extracorporeal membrane oxygenation has been increasingly used in refractory sepsis during pregnancy and the puerperium.

Human Coronavirus Infections and Pregnancy

“…Pneumonia, an important non-obstetric infectious condition, is an important cause of morbidity and mortality among pregnant women. 35 , 36 …”

Caring for two in the ICU: Pharmacotherapy in the critically ill pregnant patient

“…The invasive nature of cesarean section delivery increases the risk of systemic infections. Black race, invasive procedures such as cervical/vaginal sampling, prolonged rupture of membranes, and obesity are linked to higher maternal sepsis rates 67,68 . Lastly, it is important to remember, pregnancy results in natural immunosuppression for fetal protection which ultimately increases the risk of infections and sepsis 67 …”

L.A.V.O.E.: An Easy Mnemonic for the Initial Management of Sepsis in Obstetric Patients

“…Sepsis includes deregulation triggered by excessive stimulation of the clotting cascade. The cellular surfaces already turned into pro coagulants are responsible for complex formation, resulting in disseminated intravascular coagulation and vascular microthrombosis [19,27,34].…”

“…Diagnoses associated with sepsis may be associated with pregnancy or during pregnancy-related surgical procedures or those not related to pregnancy, but if they are more often in the obstetric population, incidental infections during pregnancy, or those acquired in the intensive care unit It is recommended to use antimicrobial combination therapy, and not mono therapy considering the clinical characteristics of the patient, place of infection and microbial prevalence[4,12,19]. During pregnancy the infections…”