Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-26T04:06:36.979Z Has data issue: false hasContentIssue false

SEPSIS IN PREGNANCY

Published online by Cambridge University Press:  19 December 2011

EILEEN SUNG*
Affiliation:
Obstetric Physician, King Edward Memorial Hospital, Subiaco, Western Australia and Internal Medicine Physician, Sir Charles Gairdner Hospital, Nedlands, Western Australia
JULIE GEORGE
Affiliation:
Consultant, Department of Medicine, Tan Tock Seng Hospital, Singapore and Visiting Consultant, K. K Women's and Children's Hospital, Singapore
MICHELLE PORTER
Affiliation:
Microbiologist and Infectious Disease Physician, Microbiology Department, Pathwest Laboratories, Princess Margaret Hospital, SubiacoWestern Australia6008.
*
Eileen Sung, Obstetric Physician, King Edward Memorial Hospital, Subiaco, Western Australia. Email: eileen.sung@health.wa.gov.au

Extract

Sepsis is associated with high morbidity and mortality worldwide. Although, it is not the major reason for intensive care unit admissions during pregnancy, several physiological changes that occur during pregnancy limit the ability of the pregnant woman to compensate for the derangements produced by severe sepsis, often resulting in severe organ dysfunction. Moreover, there are several disorders peculiar to the pregnant state, including preeclampsia, placental abruption, amniotic fluid embolism and postpartum haemorrhage, all of which can produce potentially life-threatening organ failure and may be present concurrently with sepsis contributing to maternal mortality. Evidence-based guidelines advocate assessment and monitoring aimed at early recognition and treatment of sepsis. Early goal-directed therapy, adequate blood glucose control, and corticosteroid replacement when indicated are improving outcomes in patients with severe sepsis, although most of these have not been validated in pregnancy.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Dellinger, RP, Levy, MM, Carlet, JM, Bion, J, Parker, MM, Jaeschke, R, et al: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2008; 36: 296327.CrossRefGoogle ScholarPubMed
2.Ronsmans, C, Graham, WJ. Lancet maternal survival steering group. Maternal mortality: who, when, where, and why. Lancet 2006; 368: 1189–200.CrossRefGoogle ScholarPubMed
3.Khan, P, Wojdyla, D, Say, L, Gulmezoglu, M, Look, PV. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367: 1066–74.CrossRefGoogle ScholarPubMed
4.Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118(Suppl. 1): 1203.Google Scholar
5.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.Google Scholar
6.Maharaj, D. Puerperal Pyrexia: A Review Part 1. Obstet Gynecol Surv 2007; 62: 393–99.CrossRefGoogle Scholar
7.Bone, RC, Balk, RA, Cerra, FB, Dellinger, RP, Fein, AM, Knaus, WA, et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20: 864–74.Google Scholar
8.Levy, MM, Fink, MP, Marshall, JC, Abraham, E, Angus, D, Cook, D et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical Care Med 2003; 31: 1250–56.CrossRefGoogle ScholarPubMed
9.Alberti, C, Brun-Buisson, C, Goodman, SV, Guidici, D, Granton, J, Moreno, R, et al. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Am J Respir Crit Care Med 2003; 168: 7784.CrossRefGoogle ScholarPubMed
10.Sprung, CL, Sakr, Y, Vincent, JL, Le Gall, JR, Reinhart, K, Ranieri, VM, et al. An evaluation of systemic inflammatory response syndrome signs in the sepsis occurrence in acutely ill patients (SOAP) study. Intensive Care Med 2006; 32: 421–27.CrossRefGoogle ScholarPubMed
11.Afessa, B, Green, B, Delke, I, Koch, K. Systemic inflammatory response syndrome, organ failure, and outcome in critically ill obstetric patients treated in an ICU. Chest 2001; 120: 1271–77.CrossRefGoogle Scholar
12.Duvekot, JJ, Peeters, LLH. Very early changes in cardiovascular physiology. In: Chamberlain G, Pipkin FB (eds). Clinical physiology in obstetrics. Blackwell Scientific, Oxford, 1998; 332.Google Scholar
13.Cunningham, FG, Leveno, KJ, Bloom, SL, Hauth, JC, Rouse, DJ, Spong, CY, et al: Maternal physiology. In: Williams Obstetrics. Twenty third Edition. New York, McGraw-Hill, 107–35.Google Scholar
14.Andrew, ML. Pregnancy and Critical Care Medicine Part 1: Normal Physiologic Changes in Pregnancy. Critical Care (Alert) 2011; 18: 8993.Google Scholar
15.Falagas, ME, Kompoti, M. Obesity and infection. Lancet Infect Dis 2006; 6: 438–46.CrossRefGoogle ScholarPubMed
16.Tsoi, E, Shaikh, H, Teoh, TG. Obesity in pregnancy: a major healthcare issue. Post Grad Med J 2010; 86: 617–23.CrossRefGoogle ScholarPubMed
17.Heslehurst, N, Simpson, H, Ells, LJ, Rankin, J, Wilkinson, J, Lang, R, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008; 9: 635–83.CrossRefGoogle ScholarPubMed
18.Edward, R, Yeomans, Larry C. Gilstrap III. Physiologic changes in pregnancy and their impact on critical care. Crit Care Med 2005 33: S256258.Google Scholar
19.Lewinsohn, G, Herman, A, Leonov, Y, Klinowski, E. Critically ill obstetrical patients: Outcomes and predictability. Crit Care Med 1994; 22: 1412–14.CrossRefGoogle ScholarPubMed
20.El-Solh, AA, Grant, BJ. A comparison of severity of illness scoring systems for critically ill obstetric patients. Chest 1996; 110: 1299–304.CrossRefGoogle ScholarPubMed
21.Vasquez, DN, Estenssoro, E, Canales, HS, Reina, R, Saenz, MG, Das Neves, AV et al. Clinical characteristics and outcomes of obstetric patients requiring ICU admission. Chest 2007; 131: 718–24.CrossRefGoogle ScholarPubMed
23.Somerset, DA, Zheng, Y, Kilby, MD, Sansom, DM, Drayson, MT. Normal human pregnancy is associated with an elevation in the immune suppressive CD25+ CD4+ regulatory T-cell subset. Immunology 2004; 112: 3843.CrossRefGoogle ScholarPubMed
24.Aagard-Tillery, KA. Immunology of normal pregnancy. Semin Fetal Neonat Med 2006; 11: 279–95.CrossRefGoogle Scholar
25.Lamont, RF, Sobel, J, Mazaki-Tovi, S, Kusanovic, JP, Vaisbuch, E, Kim, SK, et al. Listeriosis in human pregnancy: a systematic review. J Perinat Med 2011; 39: 227–36.CrossRefGoogle ScholarPubMed
26.Blanco, JD. Bacteremia in obstetrics: clinical course. Obstet Gynecol 1981; 58: 621–25.Google ScholarPubMed
27.Van Beneden, CA, Hicks, LA, Riley, LE, Schulkin, J. Provider knowledge, attitudes and practices regarding obstetric and postsurgical gynaecologic infections due to Group A Streptococcus and other infectious agents. Infect Dis Obstet Gynecol 2007; 2007: 90189.CrossRefGoogle ScholarPubMed
28.Paruk, F.Infections in obstetric critical care. Best Prac Res Clin Obst Gyn 2008; 22: 865–83.CrossRefGoogle ScholarPubMed
29.Joseph, J, Sinha, A, Paech, M, Walters, BNJ. Sepsis in pregnancy and early goal-directed therapy. Obstet Med 2009; 2: 9399CrossRefGoogle ScholarPubMed
30.Bernard, GR, Vincent, JL, Laterre, PF, LaRosa, SP, Dhainaut, JF, Lopez-Rodriguez, A, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344: 699709.CrossRefGoogle ScholarPubMed
31.Martí-Carvajal, AJ, Solà, I, Lathyris, D, Cardona, AF. Human recombinant activated protein C for severe sepsis. Cochrane Database Syst Rev 2011; (4): CD004388.CrossRefGoogle Scholar
32.Al-Rawi, S, Woodward, LJ, Knight, J. Puerperal streptococcal toxic shock syndrome treated with recombinant human activated protein C and intravenous immunoglobulin. Int J Obstet Anesth 2009; 18: 169–72.CrossRefGoogle ScholarPubMed
33.Medve, L, Csitári, IK, Molnár, Z, László, A. Recombinant human activated protein C treatment of septic shock syndrome in a patient at 18th week of gestation: a case report. Am J Obstet Gynecol 2005; 193: 864–65.CrossRefGoogle Scholar
34.FDA (US Food and Drug Administration) 25/10/11.Google Scholar
35.Garcia, J, Aboujaoude, R, Apuzzio, J, Alvarez, JR. Septic pelvic thrombophlebitis: diagnosis and management. Infect Dis Obstet Gynecol 2006; 2006:15614.CrossRefGoogle ScholarPubMed
36.Maharaj, D. Puerperal Pyrexia: A Review. Part II. Obstet Gynaecol Surv 2007; 62: 400406.CrossRefGoogle ScholarPubMed
37.Faro, S. Postpartum Endometritis. Clin Perinatol 2005; 32: 803–14.CrossRefGoogle ScholarPubMed
38.Viscomi, CM, Manullang, T. Maternal fever, neonatal sepsis evaluation and epidural labour analgesia. Reg Anesth Pain Med 2000; 25: 549–53.CrossRefGoogle Scholar
39.Kaitz, AL. Urinary concentrating ability in pregnant women with asymptomatic bacteriuria. J Clin Invest 1961; 40: 1331–338.CrossRefGoogle ScholarPubMed
40.Sweet, RL. Bacteriuria and pyelonephritis during pregnancy. Semin Perinatol 1977; 1: 2540.Google ScholarPubMed
41.Naeye, RL. Causes of the excessive rates of perinatal mortality and prematurity in pregnancies complicated by maternal urinary-tract infections. N Engl J Med 1979; 300: 819–23.CrossRefGoogle ScholarPubMed
42.Mittendorf, R, Williams, MA, Kass, EH. Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria. Clin Infect Dis 1992; 14: 927–32.CrossRefGoogle ScholarPubMed
43.Nicolle, LE, Bradley, S, Colgan, R, Rice, JC, Schaeffer, A, Hooton, TM et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40: 643–54.CrossRefGoogle Scholar
44.Patterson, TF, Andriole, VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am 1997; 11: 593608.CrossRefGoogle ScholarPubMed
45.Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 14. Melbourne: Therapeutic Guidelines Limited; 2010.Google Scholar
46.Dubois, V, De Barbeyrac, B, Rogues, AM, Arpin, C, Coulange, L, Andre, C et al. CTX-M-producing Eschericia coli in a maternity ward: a likely community importation and evidence of mother to neonate transmission. J Antimicrob Chemother 2010; 65: 1368–371.CrossRefGoogle Scholar
47.Gorgas, DL. Infections Related To Pregnancy. Emerg Med Clin N Am 2008: 26: 345–66.CrossRefGoogle ScholarPubMed
48.Centre for Maternal and Childhood Enquiries (CMACE). Review of Maternal Deaths in the United Kingdom related to A/H1N1 2009 Influenza. 2010 Department of Health.Google Scholar
49.French, L, Smaill, FM. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev 2004: CD001067.CrossRefGoogle Scholar
50.Patai, K, Szilágyi, G, Hubay, M, Szenttmáriay, Paulin F. Severe endometritis caused by genital mycoplamas after Caesarean section. J Med Microbiol 2005; 54: 1249–50.CrossRefGoogle Scholar
51.Hollier, LM, Scott, LL, Murphree, SS, Wendal, GD JR. Postpartum endometritis caused by herpes simplex virus. Obstet Gynecol 1997; 89: 836–38.CrossRefGoogle ScholarPubMed
52.Anteby, EY, Yagel, S, Hanoch, J, Shapiro, M, Moses, AE. Puerperal and intrapartum group A streptococcal infection. Infect Dis Obstet Gynecol 1999; 7: 276–82.CrossRefGoogle ScholarPubMed
53.Stevens, D. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis and new concepts in treatment. Emerg Infect Dis 1995: 1: 6978.CrossRefGoogle ScholarPubMed
54.Health Protection Agency. Group A Streptococcus Working Group. Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease. Commun Dis Public Health 2004; 7: 354–61.Google Scholar
55.Vandanesh, F, Naimi, T, Enright, MC, Lina, G, Nimmo, GR, Hefferman, H et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine Leukocidin genes: worldwide emergence. Emerg Infect Dis 2003; 9: 978–84.CrossRefGoogle Scholar
56.Faro, S. Postpartum Endometritis. Clin Perinatol 2005; 32: 803–14.CrossRefGoogle ScholarPubMed
57.Foxman, B, D'Arcy, H, Gillespie, BG, Bobo, JK, Schwartz, K. Lactation mastitis: Occurrence and medical management among 946 breastfeeding women in the United States. Am J Epidemiol 2002; 15: 103–14.CrossRefGoogle Scholar
58.Baskettv, TF, Sternadel, J. Maternal intensive care and near-miss mortality in obstetrics. Br J Obstet Gynecol 1998; 105: 981–84.CrossRefGoogle Scholar
59.Fernández-Pérez, ER, Salman, S, Pendem, S, Farmer, C. Sepsis in Pregnancy. Crit Care Med 2005; 33: S286293.CrossRefGoogle Scholar
60.Sheffield, JS. Sepsis and septic shock in pregnancy. Crit Care Clin 2004; 20: 651–60.CrossRefGoogle ScholarPubMed
61.Seale, AC, Mwaniki, M, Newton, CR, Berkley, JA. Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-saharan Africa. Lancet 2009; 9: 428–38.CrossRefGoogle ScholarPubMed
62.Fischer, M, Bhatnagar, J, Guarner, J, Reagan, S, Hacker, JK, Van Meter, SH et al. Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion. N Engl J Med 2005; 353: 2352–360.CrossRefGoogle ScholarPubMed
63.Meis, JF, Muytjens, HL, van den Berg, PP, Voss, A, Melchers, WJ. Analysis of an outbreak of Puerperal fever due to Group A Streptococci by random amplified polymorphic DNA fingerprinting. Infect Dis In Obstet Gynecol 1997; 5: 232–36.3.0.CO;2-9>CrossRefGoogle Scholar
64.Aldape, MJ, Bryant, AE, Stevens, DL. Clostridium sordelli infection: epidemiology, clinical findings and current perspectives on diagnosis and treatment. Clin Infect Dis 2006; 43: 1436–446.CrossRefGoogle ScholarPubMed
65.Cohen, AL, Bhatnagar, J, Reagan, S, Zane, SB, D'Angeli, MA, Fischer, M et al. Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion. Obstet Gynecol 2007; 110: 1027–33.CrossRefGoogle ScholarPubMed
66.Workowski, KA, Berman, S; Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR Recomm Rep 2010; 59: 1110.Google ScholarPubMed
67.Meyers, D, Wolff, T, Gregory, K, Marion, L, Moyer, V, Nelson, H et al. USPSTF recommendations for STI screening. Am Fam Physician 2008; 77: 819–24.Google ScholarPubMed
68.`National Institute for Health and Clinical Excellence: Guidance. Antenatal Care: Routine care for the healthy pregnant woman. March 2008 (Guideline 62).Google Scholar
69.Smaill, FM, Gyte, GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2010; CD007482.CrossRefGoogle Scholar
70.Gray, J, Patwardhan, SC, Martin, W. Methicillin-resistant Staphylococcus aureus screening in obstetrics: a review. J Hosp Infect 2010; 75: 8992.CrossRefGoogle ScholarPubMed
71.Lamont, R, Sobel, J, Kusanovic, J, Vaisbuch, E, Mazaki-Tovi, S, Kim, S et al. Current debate on the use of antibiotic prophylaxis for caesarean section. BJOG 2011; 118: 193201.CrossRefGoogle ScholarPubMed
72.Kenyon, S, Boulvain, M, Neilson, J. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2003; CD001058.CrossRefGoogle Scholar
73.Hutzal, CE, Boyle, EM, Kenyon, SL, Nash, JV, Winsor, S, Taylor, DJ et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metanalysis. Am J Obstet Gynecol 2008; 199: 620. e18.CrossRefGoogle Scholar
74.Thinkhamrop, J, Hofmeyr, GJ, Adetoro, O, Lumbiganon, P. Prophylactic antibiotic administration during second and third trimester in pregnancy for preventing infectious morbidity and mortality. Cochrane Database Syst Rev 2002; CD002250.CrossRefGoogle Scholar
75.Wilson, W, Taubert, KA, Gewitz, M, Lockhart, PB, Baddour, LM, Levison, M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 1736–54.CrossRefGoogle Scholar