Complications

Postnatal Sepsis  Mother

o Cellulitis // Necrotising Fascitis
Definition
o TSS
 Infection  Invasion of body tissues by disease-
o Venous Thrombosis
causing microorganisms
o Mortality
 Infection doesn’t equal sepsis
 Septic shock  60%
o Infection – Localised
 Fetus
o Sepsis – generalized systemic response
o Infection
Epidemiology
Classification
 Common
 Peurpural infection OR Sepsis
 Common cause of maternal moratlity
o Esp. GAS Assessment
 Signs of infection  Pyrexia // Tachycardia //
Causes
Pain (out of proportion) // Abnormal discharge
 Infection
 Is she high risk ?  Obese // DM
 DVT
 Present pregnancy history
Common Sites o Duration of ROM
o Duration of labor
o Vaginal trauma
o C/S
o Placenta complete
 Is she septic ? Low BP // Organ dysfunction
What’s the likely source ?

Less Common Sites

Common Organisms
 GAS – Streptococcus Pyogenes
o G+ve cocci
 Staphylococcus Aureus
o G+ve cocci
o MRSA
 Escherichia Coli
o G-ve rod
Risk Factors
 Demographics  Black & Minority groups
 Medical conditions  Obesity // DM // Is she septic ?
immunosuppressant drugs  Unwell // Altered LOC // Rigors // Lethargy //
 Obstetric interventions  Cerclage // Anorexia // Considerable oedma //
Amniocentesis // C/S // Vaginal trauma Maculopapular rash
 Obstetric conditions  PPROM // Multiple  May have insidious onset
vaginal examination in labor // Prolonged labour  Pyrexia >= 38 or hypothermia <=36
// RPOC // Wound haematoma  Tachycardia >= 90
 Gynaecological Conditions  Hx vaginal discharge  Tachypnea >= 20 bpm
or pelvix infection  Hypotension >=90 mmHg
 Family hx  GAS in close contacts  Decreased CRT
Investigations
 Blood cultures
 Serum lactate  >4 mmol/L
 Leucocytosis  >12X10^9 OR Leucopenia
<4X10^9 /L
o WBC with >10% immature forms
 Thrombocytopenia  <100X10^9
 CRP  >7mg/L
 DVT  S+S (Pain, redness, warmth, swelling) &
Leg doppler
Management
 Resuscitate // Help // Admit // Abx // Fluids //
Analgesics and anti-pyretics // Consider
thromboprophylaxis // Treat source of infection //
Infection control procedures
 ICU Admission
o If hypotension // Organ dysfunction
 Give antibiotics
o <=1 hour of diagnosis of suspected sepsis
o Broad spectrum antibiotics
 Co-amoxiclav
 Clindamycin // Piperacillin // Tazobactam
 Gentamicin
 Vancomycin or Teicoplanin if MRSA
o Establish any drug allergies
o Give IVIG for severe streptococcal or Staph
 Thromboprophylaxis
o TEDS
o Therapeutic LMWH if DVT suspected (until
excluded)
 Ensure clinical improvement
o Regular monitoring of vitals
o MEOWS
 Protect close contacts
o Give prophylactic antibiotics if mother has GAS
to BABY and FAMILY/STAFF
Prognosis
 Good if early treatment
 Poor if delayed treatment
Key Points
 Recent increase in maternal death from GAS
 Genital tract is MC source
 Early identification & management may be life-
saving
 Give broad-spectrum antibiotics IV <= 1 hour

 Give fluids
o Ensure adequate replacement // Beware of
overload  CVP monitoring
o May need inotropes or vasopressors
 Give analgesics and anti-pyretics
o Give paracetamol
o Avoid NSAIDS (Reduced ability of
macrophages to fight GAS)