Sepsis in Obstetrics

Abstract

Morbidity and mortality associated with sepsis has gained widespread attention on a local, state, and national level, yet, it remains a complicated disorder that can be difficult to identify in a timely manner. Sepsis in obstetric patients further complicates the diagnosis as alterations in physiology related to pregnancy can mask sepsis indicators normally seen in the general population. If early signs of sepsis go unrecognized, septic shock can develop, leading to organ dysfunction and potential death. Maternal early warning tools have been designed to assist clinicians in recognizing early indications of illness. Through use of clinical pathway-specific tools, disease processes may be detected early, subsequently benefitting patients with aggressive treatment management and intervention.This article is the second in a series of three that discuss the importance of sepsis and septic shock in pregnancy. Risk factors, causes of sepsis, signs and symptoms, and maternal early warning tools are discussed.

Maternal Sepsis

“…This implies that there is a progression of the infection even after initiation of antibiotic treatment suggesting improper diagnosis, treatment, and follow-up (Acosta et al). A signifi cant risk factor was identifi ed as an unscheduled cesarean birth that increases the risk for sepsis 5-to 20-fold when compared with a vaginal birth (Parfi tt et al, 2017b). Other risk factors that increase a mother's probability for development of sepsis are also poorly understood and include obesity, chronic hypertension, anemia, poor nutrition, history of GBS infection, lack of prenatal care, and nonwhite ethnicity (Parfi tt et al, 2017b).…”

“…This causes a reduction in oxygen reserve thereby affecting the mother's ability to compensate when a severe infection potentially leads to metabolic acidosis (Olvera & Dutra). Immunologic adaptations during pregnancy include a decrease in infl ammatory response and cell-mediated immunity causing a predisposition to infection (Parfi tt et al, 2017b). To protect the fetus, this immune response occurs to allow tolerance of fetal antigens (Gibbs et al).…”

“…To protect the fetus, this immune response occurs to allow tolerance of fetal antigens (Gibbs et al). The increased susceptibility to infection and invasion of microorganisms in the genitourinary tract is likely to cause ascending infections such as pyelonephritis and chorioamnionitis (Parfi tt et al, 2017b). Cesarean birth increases risk for development of a surgical site and endometrial infection (Olvera & Dutra).…”