Sepsis peri-pregnancy

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
• In the context of peri-pregnancy, it refers to sepsis occurring during pregnancy, at delivery, or in the postpartum period (up to six weeks after delivery).

• Sepsis is a leading cause of maternal morbidity and mortality worldwide
• The incidence is increasing due to factors such as rising rates of caesarean sections, increased maternal age, and higher prevalence of comorbidities.

• The pathogenesis of sepsis involves a complex interaction between the pathogen and the maternal immune response, leading to widespread inflammation, tissue damage, and organ dysfunction.
• Pregnancy-specific changes in the immune system and physiological adaptations can alter the presentation and progression of sepsis, complicating its diagnosis and management.

• Caesarean delivery.
• Prolonged rupture of membranes.
• Instrumental delivery.
• Intrauterine infection.
• Group B Streptococcus (GBS) colonisation.
• Anaemia.
• Immunosuppression.
• Previous pelvic infections or history of sepsis.

• Fever or hypothermia.
• Tachycardia.
• Tachypnoea or hypoxia.
• Altered mental status.
• Hypotension (late sign).
• Signs of organ dysfunction, such as oliguria, lactic acidosis, or coagulopathy.
• Specific signs related to the source of infection, e.g., uterine tenderness, foul-smelling vaginal discharge, or abdominal pain.

• Clinical diagnosis is based on the presence of suspected or confirmed infection and evidence of organ dysfunction.
• Laboratory tests to support diagnosis: complete blood count, blood cultures, lactate levels, liver enzymes, renal function tests, and coagulation profile.
• Imaging studies may be required to identify the source of infection.

Initial Management:

• Immediate initiation of broad-spectrum antibiotics after obtaining cultures.
• Fluid resuscitation and supportive care to maintain organ perfusion and oxygenation.
• Identification and management of the source of infection, which may require surgical intervention (e.g., drainage of an abscess).

Antibiotic Therapy:

• Empirical antibiotic therapy should be broad-spectrum and tailored based on the suspected source of infection, local antimicrobial resistance patterns, and adjusted according to culture results.
• Consideration of pregnancy-specific safety profiles of antibiotics.

Supportive Care:

• Management of organ dysfunction, including mechanical ventilation for respiratory failure, renal replacement therapy for acute kidney injury, and vasopressors for septic shock.
• Close monitoring in an intensive care unit may be necessary for severe cases.

• Acute respiratory distress syndrome (ARDS).
• Acute kidney injury.
• Disseminated intravascular coagulation (DIC).
• Septic shock.
• Maternal death.
• Adverse foetal outcomes, including preterm birth, foetal distress, and stillbirth.

• Identification and treatment of infections during pregnancy and the postpartum period.
• Prophylactic antibiotics as indicated, for example, during caesarean delivery or for GBS colonisation.
• Vaccinations against influenza and pertussis during pregnancy.

• Sepsis during the peri-pregnancy period is a critical condition that poses significant risks to both the mother and the foetus.
• Early recognition, prompt initiation of empirical antibiotic therapy, and aggressive supportive care are crucial to improve outcomes.
• Understanding the unique physiological changes during pregnancy that can affect the presentation and management of sepsis is essential for medical students and healthcare professionals involved in obstetric care.