Download - 10. sepsis rev 19.5.10
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
?
RECAP
Recognition of pregnancy related Sepsis
Causes
Principles of Management