6 - Sepsis and septicshock in pregnancy

Summary

This chapter discusses the pathophysiology, implications, diagnostic signs and diagnostic signs of sepsis and septic shock in pregnancy. In severe sepsis the key pathology is endothelial dysfunction (endothelial apoptosis, increased expression of adhesion molecules and increased capillary permeability) and disordered coagulation homeostasis. It is also important to note that the signs and symptoms of sepsis can be non-specific. The principles of treatment revolve around the basic elements of resuscitation (Airways, Breathing, and Circulation), treatment of the underlying infection including surgical drainage or excision, and organ support until recovery. The use of Modified Early Obstetric Warning System (MEOWS) charts has been shown to minimise risk in the unwell obstetric patient. Prophylactic antibiotic administration is recommended in a number of clinical scenarios to prevent infection in women considered to be at risk. Adjuvant interventions includes surgical removal of infections, use of low-dose steroids and administering activated protein C, an exogenous anticoagulant.