Document Detail


Severe sepsis and septic shock in pregnancy.
MedLine Citation:
PMID:  22914482     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. This improvement can be achieved by formulating a stepwise approach that consists of early provision of time-sensitive interventions such as: aggressive hydration (20 mL/kg of normal saline over the first hour), initiation of appropriate empiric intravenous antibiotics (gentamicin, clindamycin, and penicillin) within 1 hour of diagnosis, central hemodynamic monitoring, and the involvement of infectious disease specialists and critical care specialists familiar with the physiologic changes in pregnancy. Thorough physical examination and imaging techniques or empiric exploratory laparotomy are suggested to identify the septic source. Even with appropriate antibiotic therapy, patients may continue to deteriorate unless septic foci (ie, abscess, necrotic tissue) are surgically excised. The decision for delivery in the setting of antepartum severe sepsis or septic shock can be challenging but must be based on gestational age, maternal status, and fetal status. The natural inclination is to proceed with emergent delivery for a concerning fetal status, but it is imperative to stabilize the mother first, because in doing so the fetal status will likewise improve. Aggressive [corrected] treatment of sepsis can be expected to reduce the progression to severe sepsis and septic shock and prevention strategies can include preoperative skin preparations and prophylactic antibiotic therapy as well as appropriate immunizations.
Authors:
John R Barton; Baha M Sibai
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  120     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-23     Completed Date:  2012-10-29     Revised Date:  2012-12-18    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  689-706     Citation Subset:  AIM; IM    
Affiliation:
Division of Maternal-Fetal Medicine, Central Baptist Hospital, Lexington, Kentucky, USA. jbarton@bhsi.com
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Anti-Bacterial Agents / therapeutic use
Blood Transfusion
Chorioamnionitis / diagnosis,  therapy
Endometritis / diagnosis,  therapy
Fasciitis, Necrotizing / diagnosis,  therapy
Female
Fluid Therapy
Humans
Insulin / therapeutic use
Pneumonia / diagnosis,  therapy
Pregnancy
Pregnancy Complications, Infectious* / diagnosis,  epidemiology,  etiology,  therapy
Pyelonephritis / diagnosis,  therapy
Resuscitation
Sepsis* / diagnosis,  epidemiology,  etiology,  therapy
Shock, Septic / diagnosis,  etiology,  prevention & control,  therapy
United States / epidemiology
Vulvitis / diagnosis,  therapy
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Anti-Bacterial Agents; 0/Insulin
Comments/Corrections
Erratum In:
Obstet Gynecol. 2012 Nov;120(5):1214

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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