Sepsis during pregnancy or the postpartum period

Galvão, Ana; Braga, António; Gonçalves, Daniela; Guimarães, Joana; Braga, Jorge

doi:10.3109/01443615.2016.1148679

Cited by 25 publications

(33 citation statements)

References 70 publications

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“…Due to the physiological changes that occur during pregnancy, hemodynamic signs of septic shock manifest late in its course, and therefore, its recognition can be elusive [32]. Likewise, a recent retrospective study that included 45 patients with the diagnosis of clinical chorioamnionitis at term found that the clinical signs of chorioaminiotis did not accurately identify patients with microbial-associated intra-amniotic infection or inflammation [33]. For the identification of patients with microbial-associated intra-amniotic inflammation, the study found that maternal tachycardia, leukocytosis, and fetal tachycardia had a low specificity, and foul-smelling vaginal discharge, and also, uterine tenderness had poor sensitivity [33].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Burgess

Katz

Moretti

et al. 2017

Gynecol Obstet Invest

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Aim: To determine factors associated with intrapartum fever and to examine associated maternal and neonatal outcomes. Methods: Retrospective study of patients between 36^0/7 and 42^0/7 gestational weeks who entered spontaneous or induced active labor and developed temperature ≥38°C; a similar group that did not develop fever were controls. Univariate and multivariate analyses were performed with p < 0.05 as significant. Results: Fifty-four febrile patients and 306 nonfebrile controls met inclusion criteria. Nulligravidity (45.8 vs. 77.8%, p < 0.001), length of first stage ≥720 min (OR 3.59, 95% CI 1.97-6.55, p < 0.001), length of second stage ≥120 min (OR 4.76, 95% CI 2.29-9.89, p < 0.001), membrane rupture ≥240 min (46.4 vs. 79.6%, p < 0.001), increasing number of vaginal exams (4 vs. 6, p < 0.001), oxytocin (44.8 vs. 63.0%, p = 0.014), and meperidine (14.7 vs. 35.2%, p < 0.001) were all associated with intrapartum fever. Associated morbidity included cesarean delivery (22.5 vs. 44.4%, p = 0.001), Apgar score <7 at 5 min (0.7 vs. 5.6%, p = 0.011), and neonatal intensive care unit admission (9.5 vs. 51.9%, p < 0.001). Conclusion: We have identified several noninfectious factors that are associated with intrapartum fever. Modification of risk factors may improve both maternal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Burgess

Katz

Moretti

et al. 2017

Gynecol Obstet Invest

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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] 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.…”

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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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“…Adequate volume expansion to optimize cardiac output, antibiotic regimens to treat gram negative, gram positive and anaerobic infections along with invasive haemodynamic monitoring to guide inotropic therapy is indicated as per the recent guidelines of surviving sepsis compaign. [6] Amniotic fluid embolism (AFE): AFE is a clinical diagnosis of exclusion and has a high mortality rate. The biomarkers used for diagnosis include Zinc corproporphyrin-1, Sialyl Tn antigen (STN), Complement C-3, C-4, interlukin-8, insulin-like growth factor-binding protein-1.…”

Section: Specific Obstetric Emergenciesmentioning

confidence: 99%

Obstetric Critical Care: Overview of Relevant Issues

Gupta¹

2017

IJAR

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Sepsis during pregnancy or the postpartum period

Cited by 25 publications

References 70 publications

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Lactic acid as an adjuvant marker in pregnancy-associated sepsis

Obstetric Critical Care: Overview of Relevant Issues

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