SEPSIS

Aims

To recognise sepsis

To practise an effective response to a

woman with sepsis

To achieve competence in those skills

Sepsis

Major cause of maternal mortality

In labour and Delivery:

Suspect if fever, preterm labour, foul

smelling watery discharge

After delivery:

Suspect if fever +/- offensive lochia and

boggy uterus

Causes of fever during

pregnancy and after delivery

Septic abortion

Chorioamnionitis

UTI (pyelonephritis)

Chest infection

Phlebitis

Hepatitis

Causes of fever during

pregnancy and after delivery

Puerperal sepsis (Endometritis, pelvic

abscess, peritonitis)

Wound infections

Mastitis, breast abscess

Meningitis

Malaria, enteric fever

Recognition of Sepsis

Fever: temperature > 38 oC

Warm extremities

Fast breathing

Increased maternal and fetal heart rate

Altered mental state

Low BP

Septic shock

General Management Principles

ABCs

If conscious, increase oral fluid intake and in all start iv fluids

Treat fever

Start iv antibiotics

Treat underlying causes

Prompt REFERAL

General Management Principles

• Antibiotic therapy (AGM)

Not Severe: oral ampicillin 1g, 80mg gentamicin

IM, oral metronidazole 400mg

Severe: IV ampicillin 1g stat, 80mg gentamicin IM

IV metronidazole 500mg

Endometritis

Should be considered in any case of post

partum fever

May progress to pelvic abscess, peritonitis,

septic shock, or chronic pelvic infection with

infertility

Treat with parenteral antibiotics until fever free

If fever persists after 72 hours, re-evaluate

Consider digital exploration for retained products

Consider laparotomy

Abdominal or perineal wounds

If pus or fluid, remove sc sutures, drain and debride, damp dressing in wound and replace every 24 hours

If superficial ampicillin and metronidazoleorally

If deep and causing muscle necrosis give AGM IV and REFER

UTI

Cysitis:

Ampicillin 500mg orally QDS for 3-5 days or

Cotrimoxazole160/800mg orally BD for 3-5 days

If infection recurs : Check C&S, give prophylaxis

Pylonephritis:

Ampicillin 2g IV +gentamicin 80mg IM

Once afebrile for 48 hrs give amoxycillin for 14/7

Give prophylaxis for remainder of pregnancy

and 2 weeks post partum

Breast engorgement and Mastitis

If baby not suckling express milk

Express milk before suckling to soften

nipple area

Apply compresses and shower before

suckling

Support breasts

Analgesia: paracetamol

If mastistis develops: Oral ampicillin or

erythromycin for 10 days

Breast Abscess

Continue feeding-use other breast

Support and cold compresses for breast

Paracetamol

Oral ampicillin or erythromycin for 10/7

REFER for I&D

Malaria

Likely cause of fever in pregnant woman in

endemic area (but is not sepsis)

Can be severe in pregnant women

Check for malaria parasites if possible

For uncomplicated malaria give first line

treatment

Chloroquine 10mg/kg + primaquine

0.25mg/kg

Typhoid

Suspect if persistent fever, headache,

abdominal pain, constipation,

diarrhoea, cough, palpable spleen,

relative bradycardia

Give ampicillin 1 g by mouth four times for

14 days

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RECAP

Recognition of pregnancy related Sepsis

Causes

Principles of Management