New Concept and Management for Sepsis in Pregnancy and the Puerperium
10.1097/FM9.0000000000000058
- VernacularTitle:New Concept and Management for Sepsis in Pregnancy and the Puerperium
- Author:
Shang-Rong FAN
1
;
Ping LIU
;
Shao-Mei YAN
;
Lei HUANG
;
Xiao-Ping LIU
Author Information
1. Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China; Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecological Diseases, Shenzhen 518036, China
- Publication Type:Journal Article
- Keywords:
Sepsis;
Pregnancy;
Puerperium;
Maternal;
Fetal;
Morbidity;
Mortality;
Maternal near-miss
- From:
Maternal-Fetal Medicine
2020;02(4):231-239
- CountryChina
- Language:English
-
Abstract:
Sepsis, which is life-threatening organ dysfunction resulting from a dysregulated host response to infection, remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leading causes of maternal morbidity and mortality. The obstetric causes include uterine infection, septic abortion, and wound infection. The non-obstetric causes include pyelonephritis and pneumonia. Maternal sepsis may also be from obstetrical critical illness, such as obstetric severe hemorrhage, obstetric (amniotic fluid/pulmonary) embolism, acute fatty liver of pregnancy, and congestive heart failure, cardiopulmonary arrest, and major trauma. The most commonly reported pathogens in maternal sepsis include Escherichia coli, Streptococcus, Staphylococcus, and other gram-negative bacteria. Maternal sepsis may cause intrauterine infection, which results in (1) preterm premature rupture of membranes or preterm labor or birth, (2) cerebral white matter damage or cerebral palsy or neurodevelopmental delay, (3) stillbirth, (4) early- or late-onset sepsis, and (5) perinatal death. The "Hour-1 bundle" should be initiated within the first hour of the recognition of sepsis. The use of early, appropriate antibiotics is crucial in the management of maternal sepsis. Fetal status should be monitored. Appropriate and early source control should be provided. The decision for delivery is often quite complex and should be individualized to each patient’s clinical scenario while taking into consideration the suspected source of infection, maternal status, fetal well-being, and gestational age. Extracorporeal membrane oxygenation has been increasingly used in refractory sepsis during pregnancy and the puerperium.
