Sepsis and Pregnancy
OVERVIEW
Pregnancy results in increased susceptibility to endotoxin, metabolic acidosis and cardiovascular collapse
SOURCES OF SEPSIS
- chorioamionitis
- post partum endometritis
- UTI
- pyelonephritis
- septic abortion
- necrotizing fasciitis
- episiotomy infections
COMMON ORGANISMS
- Gram negatives > Gram positives
- Gram Negative – E.coli, Klebsiella, Enterobacter, Proteus, Pseudomonas aeruginosa, Bacteroides
- Gram Positive – Staph aureus, Group A Beta haemolytic streptococcus, Group B streptococcus, Enterococcus, Listeria monocytogenes, Clostridium, Peptostreptococuss
- Fungi
DIAGNOSTIC DIFFICULTIES
Applying the SIRS criteria to pregnancy can be problematic as there is normally:
- leucocytosis
- increased body temperature (during pregnancy and labour)
- tachycardia and tachypnoea are seen during normal labour
- already have a hyperdynamic circulation
– warm and well perfused, high cardiac output, increased blood volume, relative increase in HR
– these normal change in pregnancy also are present in sepsis. - can compensate well and then quickly decompensate (like the paediatric patient)
- altered signs
– appendicitis is more difficult to diagnose clinically due to gravid uterus displacement
— UTI’s may be asymptomatic
— pneumonia/LRTI’s masked as a degree of breathlessness in normal in late pregnancy
MANAGEMENT
Goals
- source control
- empiric antibiotics (imipenem)
- supportive care
Antibiotics contraindicated in pregnancy
- Tetracyclines
- Fluroquinolones
- Aminoglycosides
- Chloramphenicol
- Trimethoprim (1st trimester)
- Nitrofurantoin
- Vancomycin
- Anti-fungals – triazoles, terbinafine
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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