28 – Group A Streptococcal Puerperal Sepsis

28 Group A Streptococcal Puerperal Sepsis

Laura Coleman and Melissa Whitworth

Scenario in a Nutshell

Postpartum woman develops Group A streptococcal septic shock.

Stage 1: Initial assessment with initiation of management for sepsis.

Stage 2: Deteriorating hypotensive patient not responding to fluid boluses – septic shock.

Stage 3: Commence vasopressors and plan for invasive monitoring and transfer to critical care.

Target Learner Groups

All members of the multidisciplinary obstetric team: anaesthetists, midwives, obstetricians, operating department practitioners/anaesthetic nurses.

Specific learning opportunities
Early recognition of a deteriorating septic patient
Knowledge of the management of sepsis with appropriate escalation of treatment
Effective team management of an acutely unwell obstetric patient with appropriate senior and multidisciplinary involvement
Suggested learners (to represent their normal roles) In the room from the start Available when requested
Anaesthetic ST3+
Obstetric ST3+
Midwife coordinator
Midwife in room
Operating Department Practitioner (ODP)/anaesthetic nurse
Suggested facilitators
Faculty to play role of ward midwife giving SBAR handover to midwife and obstetric ST3+ at start of scenario

Details for Facilitators

Patient Demographics

Name: Eva

Age: 32

Gestation: 1 day post partum

Booking weight: 80 kg

Parity: P1

Scenario Summary for Facilitators

32-year-old, now P1 woman, had a normal vaginal delivery at 40+5 weeks, then had repair of a third-degree tear in theatre.

She is now 18 hours post-delivery with swinging temperatures, lower abdominal pain and foul smelling lochia.

She develops a tachycardia then hypotension.

Unresponsive to intravenous crystalloid infusion.

Diagnosis of septic shock.

Resuscitation with antibiotics, intravenous crystalloid and vasopressors.

Safe planning of transfer to critical care.

Set-up Overview for Facilitators

Clinical setting On a postnatal ward bed
Patient position Semi-recumbent
Initial monitoring in place None
Other equipment None

Medical Equipment

For core equipment checklist, see Chapter 9.

Additional equipment specific to scenario
  • Antibiotics: (or as per local guidelines)

  • Co-amoxiclav

  • Benzypenicillin

  • Clindamycin

  • Tazocin

Local microbiology antibiotic guidelines Arterial line
  • Cardiovascular drugs:

  • Metaraminol

  • Phenylephrine

  • Noradrenaline

CVP line

Information Given to the Learners

Information given to obstetric trainee and midwife who are taking over care of patient from the current ward midwife (facilitator)
  • Time: 15:00

  • The SBAR handover is as follows:

  • Situation: This is Eva, she has just called me because she is not feeling well.

  • Background: 32-year-old, previously fit and well primip who had a normal delivery yesterday at 40+5 weeks and then went to theatre for repair of a third-degree tear. She has no allergies.

  • She has started to feel generally unwell and has had some lower abdominal pain on and off today.

  • Action: I was just about to do some observations.

  • Recommendation: Are you OK to take over Eva’s care?

Scenario Schedule

Figure 28.1 ECG.

Suggested Topics for Debrief Discussion

  • Were the ‘sepsis 6’ completed in a timely manner?

  • Was there early escalation of management to involve anaesthetics and intensive care and senior obstetricians and anaesthetists?

  • Was there any problem locating any drugs/equipment needed: e.g. broad-spectrum IV antibiotics, clindamycin, noradrenaline?

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Oct 24, 2020 | Posted by in OBSTETRICS | Comments Off on 28 – Group A Streptococcal Puerperal Sepsis

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