An overview of haematological, renal and gastrointestinal changes in pregnancy and sepsis

Sepsis is a whole body inflammation resulting from infection, when severe it can result in organ dysfunction and eventual failure.

The maintenance of good hygiene and health of the mother during pregnancy and labour is important to an obstetrician and midwife. As the mother draws closer to giving birth, her body and its ability to fight off infection is reduced. A pregnancy plan produced by a medical professional like Dr Gary Swift, a leading obstetrician located on the Gold Coast specialising in gynaecology and reproductive medicine, is essential to a successful pregnancy.

In this article we take a look at the physical and internal changes during pregnancy and compare them with the changes resulting from sepsis. We also look at the consequential changes should sepsis become severe for a pregnant mother.

Physical changes during pregnancy – Haematological

  • Hypercoagulable state (elevated factors I, II, VII, VIII, IX, and XII, Plasminogen activator inhibitor I and II increase 5-fold, reduced protein S)
  • Antithrombin and protein C levels are not significantly affected
  • Mild increase in white cell counts with possibility of gestational
  • Thrombocytopenia

Physical changes resulting from sepsis – Haematological

  • Procoagulant effects
  • Increased thrombin production with reduced activated Protein C release associated with platelet aggregation
  • Decreased fibrinolysis via increase in plasminogen activator inhibitor 1 activity
  • Combined increases microvascular fibrin thrombi resulting in tissue hypoperfusion and end organ dysfunction
  • Careful interpretation of blood results

Physical changes during pregnancy – Renal

  • Renal plasma flow and the glomerular filtration rate (GFR) increase resulting in decreased serum levels of blood urea, nitrogen and creatinine.
  • The renal collecting system dilates because of smooth muscle relaxation associated with mechanical obstruction of the ureter.

Physical changes resulting from sepsis – Renal

  • Acute tubular necrosis could develop because of ischaemia reperfusion injury, vasoconstriction caused by increased renal sympathetic and angiotensin activity, and cytokine mediated renal cell injury
  • Combined misinterpretation of blood results
  • Predisposition to urinary tract infection

Physical changes during pregnancy – Gastrointestinal

  • Smooth muscle tone is reduced throughout the gastrointestinal system that results in delayed gastric emptying
  • Alkaline phosphatase levels are raised due to placental production while the transaminases and bilirubin remain unchanged during pregnancy

Physical changes resulting from sepsis – Gastrointestinal

  • Bacterial overgrowth in the upper gastrointestinal tract
  • Depressed gut’s normal barrier function
  • Combined predisposition to oesophageal reflux disease and aspiration pneumonia

references
Andrew ML. Pregnancy and Critical Care Medicine Part 1: Normal Physiologic Changes in Pregnancy.
Critical Care (Alert) 2011; 18: 89–93.

Edward R, Yeomans Larry C. Gilstrap III. Physiologic changes in pregnancy and their impact on critical
care. Crit Care Med 2005 33: S256–258.