Sepsis and pregnancy: do we know how to treat this situation?

Abstract

Sepsis is defined as an acute inflammatory response syndrome secondary to an infectious focus. It has a high incidence, morbidity and mortality, causing substantial financial costs, especially due to complications such as septic shock and multiple organ dysfunction. The pathogen toxins associated with individual susceptibility culminate with cytokine release, which promotes a systemic inflammatory response that can progress to multiple organ dysfunction and eventual patient death.Specifically, sepsis incidence, morbidity and mortality are lower in pregnant women, as this group is typically younger with fewer comorbidities having a polymicrobial etiology resulting in sepsis.Pregnant women exhibit physiological characteristics that may confer specific clinical presentation and laboratory patterns during the sepsis course. Thus, a better understanding of these changes is critical for better identification and management of these patients. The presence of a fetus also requires unique approaches in a pregnant woman with sepsis.Sepsis treatment is based on certain guidelines that were established after major clinical trials, which, unfortunately, all classified pregnancy as a exclusion criteria.Thus, the treatment of sepsis in the general population has been extrapolated to the pregnant population, with the following main goals: maintenance of tissue perfusion with fluid replacement and vasoactive drugs (initial resuscitation), adequate oxygenation, control of the infection source and an early start of antibiotic therapy, corticosteroid infusion and blood transfusion when properly indicated, prophylaxis, and specifically monitoring and maintenance of fetal heath.

Rhein inhibits lipopolysaccharide-induced intestinal injury during sepsis by blocking the toll-like receptor 4 nuclear factor-κB pathway

“…The onset of sepsis usually occurs following an excessive or uncontrolled inflammatory response (18). The causal relationship between intestinal damage and sepsis indicates that the intestinal tract is not only a target organ, but also the starting point of sepsis (5,19).…”

Necrotizing soft tissue infection in pregnancy

“…In the obstetric context, the assessment of fetal vitality has particular relevance, as the balance between fetal oxygen supply and consumption might be severely altered. No study has yet analyzed the best approach for fetal vitality assessment under this circumstance [18]. The best approach to ensure fetal vitality is to stabilize the mother's condition.…”

“…The aim of initial hemodynamic resuscitation is to restore tissue perfusion to an adequate level and to ensure that cell metabolism and oxygen supply return to normal levels to avoid acidosis and consequent multiorgan dysfunction. In pregnancy, one further aim of initial hemodynamic resuscitation is to improve fetal vitality [18,19].…”

The Critically Ill Obstetric Patient Part 1

“…26 Independent risk factors for acute antepartum pyelonephritis during pregnancy are nulliparity, untreated asymptomatic bacteriuria, and younger maternal age. Urogenital tract infection is the most frequent cause of sepsis in the obstetric population and is mostly caused by gram-negative bacteria.…”