Obstetric Sepsis

Brown, Kellie N.; Arafeh, Julie M.R.

doi:10.1097/jpn.0000000000000115

Cited by 11 publications

(9 citation statements)

References 30 publications

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“…[1] The evidence for the role of lactic acid as a potential marker for critical care in PAS is still scanty. [2][3][4][5] In pregnant patients, lactic acid levels >2mmol/L indicate tissue hypoxia and >4 mmol/L is associated with severe tissue hypoxia. [4] It is also considered to be one of the reasons for metabolic acidosis.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] In pregnant patients, lactic acid levels >2mmol/L indicate tissue hypoxia and >4 mmol/L is associated with severe tissue hypoxia. [4] It is also considered to be one of the reasons for metabolic acidosis. [4] Notably, a study of 159 pregnant women showed that increased lactic acid levels were associated with adverse maternal and perinatal outcomes, such as the need for critical care, positive blood cultures, preterm delivery and prolonged hospital admission.…”

Section: Discussionmentioning

confidence: 99%

“…[4] It is also considered to be one of the reasons for metabolic acidosis. [4] Notably, a study of 159 pregnant women showed that increased lactic acid levels were associated with adverse maternal and perinatal outcomes, such as the need for critical care, positive blood cultures, preterm delivery and prolonged hospital admission. [2] The mean lactic concentration was higher in patients admitted to the intensive care unit (2.6 v. 1.6 mmol/L; p=0.04) and in those with positive blood cultures (2.2 v. 1.6; p<0.01).…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] The only focused study of lactic acid measurements in obstetric sepsis indicated it as a marker of severe infection, associated with positive blood cultures, increased risk of intensive care unit ICU and telemetry unit admission and longer hospital stays.…”

Section: Researchmentioning

confidence: 99%

“…[1] The existing evidence on the subject is still scanty. [2][3][4][5] The only focused study of lactic acid measurements in obstetric sepsis indicated it as a marker of severe infection, associated with positive blood cultures, increased risk of intensive care unit ICU and telemetry unit admission and longer hospital stays. [2] Presently, the lactic acid estimations have been included in the diagnostic criteria of the Sepsis Obstetrics Score (SOS) and Surviving Sepsis Campaign care bundles.…”

mentioning

confidence: 99%

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Lactic acid as an adjuvant marker in pregnancy-associated sepsis

et al. 2018

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RESEARCHBackground. Lactic acid level is one index which is currently actively researched for its role in pregnancy-associated sepsis (PAS). We aimed to quantify the severity of PAS using lactic acid levels. Methods. All pregnant, post-abortal (2 weeks) and postpartum women (up to 6 weeks) with clinical sepsis were enrolled as per systemic inflammatory response syndrome criteria, and lactic acid levels were estimated at admission. Severe PAS was defined as one or more organ dysfunctions due to sepsis. The severity of obstetric sepsis was graded according to number of organ failures. Results. There were 42 patients with non-severe PAS, and 58 with severe PAS. The ≥4 mmol/L lactic acid threshold had 88.10% specificity and 37.93% sensitivity for detection of severe PAS. A significant difference (p=0.006) was found between lactic acid levels (mean (standard deviation (SD)) in cases with single OF (n=24; 3.02 (0.92) mmol/L) v. multi-organ failure (n=34; 3.70 (0.81) mmol/L). The mean (SD) lactic acid levels (3.76 (0.97) mmol/L) with any type of culture-positive PAS cases (n=35) were significantly higher than in culture-negative PAS cases (2.95 (0.98); p=0.0001). Conclusions. Lactic acid level ≥4 mmol/L had reasonable specificity for severity and culture positivity in PAS. A serum lactic acid level ≥3 mmol/L was associated with more number of organ failures. Lactic acid as an adjuvant marker in pregnancy-associated sepsis Lactic acid is one of the products of anaerobic metabolism related to hypovolemia and hypoxia. Following the recognition of lactic acid importance in critical care management of sepsis in general, its use was extended to pregnancy-associated sepsis (PAS).[1] The existing evidence on the subject is still scanty. [2][3][4][5] The only focused study of lactic acid measurements in obstetric sepsis indicated it as a marker of severe infection, associated with positive blood cultures, increased risk of intensive care unit ICU and telemetry unit admission and longer hospital stays.[2] Presently, the lactic acid estimations have been included in the diagnostic criteria of the Sepsis Obstetrics Score (SOS) and Surviving Sepsis Campaign care bundles. [3,6] Low-income countries have high burdens of morbidity and mortality related to PAS. The increasing severity of PAS worsens the maternal prognosis, and therefore there is a strong need to develop parameters for its identification to optimise outcomes. Lactic acid level is one index that is currently being researched for its role in PAS. We therefore conducted this study with the aim of quantifying the severity of PAS using lactic acid levels. We also compared the culture positivity in obstetrics sepsis with lactic acid levels, to try to find a possible association between them. MethodsEthics clearance was obtained from the Institutional Ethical Committee and prior consent was obtained from all patients. All pregnant, post-abortal (2 weeks) and postpartum women (up to 6 weeks) with clinical sepsis were investigated using systemic inflammatory response syndrome cr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

mentioning

confidence: 99%

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Lactic acid as an adjuvant marker in pregnancy-associated sepsis

et al. 2018

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Sepsis in Pregnancy

Albright

Mehta

Rouse

et al. 2016

Journal of Perinatal &Amp; Neonatal Nursing

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Sepsis accounts for up to 28% of all maternal deaths. Prompt, appropriate treatment improves maternal and fetal morbidity and mortality. To date, there are no validated tools for identification of sepsis in pregnant women, and tools used in the general population tend to overestimate mortality. Once identified, management of pregnancy-associated sepsis is goal-directed, but because of the lack of studies of sepsis management in pregnancy, it must be assumed that modifications need to be made on the basis of the physiologic changes of pregnancy. Key to management is early fluid resuscitation and early initiation of appropriate antimicrobial therapy directed toward the likely source of infection or, if the source is unknown, empiric broad-spectrum therapy. Efforts directed at identifying the source of infection and appropriate source control measures are critical. Development of an illness severity scoring system and treatment algorithms validated in pregnant women needs to be a research priority.

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Chorioamnionitis at Term

Burke

Chin

2016

Journal of Perinatal &Amp; Neonatal Nursing

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Chorioamnionitis is a serious complication during labor at term and is associated with adverse neonatal outcome affecting approximately 10% of pregnancies. It is diagnosed clinically or microbiologically or by histopathologic examination of the placenta and umbilical cord. The clinical criteria for chorioamnionitis found in preterm or term women include maternal fever combined with 2 or more findings of maternal tachycardia, fetal tachycardia, leukocytosis, uterine tenderness, and/or malodorous amniotic fluid. These subjective findings are neither sensitive nor specific. However, clinical chorioamnionitis requires a high index of suspicion, timely diagnosis, prompt antibiotic treatment, and delivery, which may help reduce the potentially devastating outcome of maternal and neonatal infections. This article focuses on clinical chorioamnionitis and presents the physiologic immune response during pregnancy, the definition of chorioamnionitis, clinical diagnostic criteria, and implications for practice.

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Obstetric Sepsis

Cited by 11 publications

References 30 publications

Lactic acid as an adjuvant marker in pregnancy-associated sepsis

Lactic acid as an adjuvant marker in pregnancy-associated sepsis

Sepsis in Pregnancy

Chorioamnionitis at Term

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