The term sepsis refers  to the presence of pyogenic or other pathogenic organisms and their toxins in tissues or in the blood. Shock is the inability (regardless of the underlying cause) for  the circulatory system to maintain adequate cellular perfusion. Inadequate perfusion at the cellular level, leads to membrane dysfunction, metabolic derangement, and finally cell death.

This explanation of sepsis has been taken from ‘Infectious Diseases in Obstetrics and Gynecology’ 2:190-201 (1994) (C) 1994 Wiley-Liss, Inc.

Puerperal Sepsis according to WHO

The World Health Organisation defines puerperal sepsis as

“infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum in which 2 or more of the following are present; pelvic pain, fever, abnormal vaginal discharge, abnormal smell of discharge and/or delay in the rate of reduction of size of uterus”.

This definition was sourced from – The Prevention And Management of Puerperal Infections: Report of a Technical Working Group, Geneva, 20–22 May 1992. Geneva: World Health Organization, Division of Family Health, 1995.

 

Puerperal Sepsis and maternal mortality

Sung et al presents the case of puerperal sepsis being one of the leading causes of maternal mortality around the world. Severe sepsis can cause severe organ dysfunction. Due to the physiological changes that a woman undergoes during pregnancy, their ability to compensate for sepsis is limited.

Reference to this statement can be found in – EILEEN SUNG, JULIE GEORGE and MICHELLE PORTER (2011). SEPSIS IN PREGNANCY. Fetal and Maternal Medicine Review, 22, pp 287-305 doi:10.1017/S0965539511000155

 

Puerperal Sepsis disorders

Some of the disorders that may appear together with sepsis are:

  • preeclampsia

    • possible indications include  the accumulation of fluid in the lungs, newly experienced brain or visual disturbance, impairment to the liver or a a low blood platelet count.

    • If left untreated, preeclampsia can develop into seizures during pregnancy.

  • placental abruption

    • possible indications include late pregnancy bleeding resulting from the separation of the placental lining from the uterus of the mother – this can occur between 20 weeks after gestation and birth.

  • amniotic fluid embolism

    • resulting from the presence of fetal cells, hair or amniotic fluid in the mother’s bloodstream, which can trigger an allergic reaction – a reaction that triggers a heart and lung collapse.

  • postpartum haemorrhage

    • involves the excessive loss of blood following childbirth.

 

Sepsis and early recognition

Early recognition is important to be able to provide prompt therapy which may include:

  • A blood test taken within 1 hour of the diagnosis of sepsis

  • The initial management within the first 6 hours of aggressive resuscitation with frequent clinical assessment of organ perfusion. Correction of metabolic parameters and fetal monitoring.

  • Antibiotic treatment according to the source of infection and local guidelines of medical response

  • 48 hours after diagnosis a reassessment should take place to reduce the risk of resistance development.

 

Dr Gary Swift is a leading Obstetrician on the Gold Coast and delivers expert medical care during the entire course of pregnancy. Should you wish to make enquiries with the Dr Gary Swift Clinic Ph (07) 5564 6017 or contact the Gold Coast clinic online via contact us.