Learning Objectives
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Recognize warning signs of maternal sepsis.
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Identify initial treatment strategies for maternal sepsis.
Definitions
Systemic Inflammatory Response Syndromes (SIRS)
Defined by two or more of the following:
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Temperature >38 or <36°C
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Heart rate >90 beats per minute
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Respiratory rate >20 breaths/minute or PaCO 2 <32 mmHg
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White blood cells >12,000 cells/mm 3 or <4000 cells/mm 3 or >10% bands
Sepsis
Defined by SIRS with a source of infection .
Severe Sepsis
Defined by sepsis with end organ dysfunction ( Fig. 21.1 ).
Surviving Sepsis Guidelines
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Within first 3 hours
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Measure lactate level
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Obtain blood cultures
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Sepsis Simulation
Materials Needed
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Manikin or volunteer to act as standardized patient
Key Personnel
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Attending obstetrician
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Resident physician (if available in your institution)
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Two nurses
Sample Scenario
A 25-year-old G3P2112 at 37 weeks 2 days gestation presents with abdominal pain, diarrhea, and decreased fetal movement. She was treated for a urinary tract infection 3 weeks ago. She states she has been leaking fluid for approximately 2 weeks. Speculum exam does not demonstrate any fluid. Her vitals are as follows: BP 90/60, HR 140, T 39.1, SpO 2 99%.
Debriefing and Documentation
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Potential sources of infection
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Systemic Inflammatory Response Syndrome criteria
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Evidence of organ dysfunction
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Initial resuscitation
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Antimicrobials
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Plan for ongoing monitoring and management
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Communication with patient and family
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