Sepsis in pregnancy. Sepsis in pregnancy Case report 31 y , G2Ab1 , second marriage, 19w Second inf. 7yr spontaneous pregnancy PNC: in private clinic.

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Presentation transcript:

Sepsis in pregnancy

Case report 31 y , G2Ab1 , second marriage, 19w Second inf. 7yr spontaneous pregnancy PNC: in private clinic PSH:curettage,laparascopy,rhinoplasty LMP:95/2/16 8-19 w 6timesPNC

Case report

Case report 97/6/1

Case report 95/6/20 CC:ROM (18w) no documentation for work up 95/6/24 ROMsonoAFI:5.12cmadvise for rest ROM  hospitalization 95/6/28

Case report 97/6/1

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Case report 97/6/1

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Case report Problems Late diagnosis & management of PROM Deficient data in patient file Imperfect documentation No inform patient & her husband correctly No direct visit by doctor in time Cercellage without indication Late consult with attending Diclofenac order

DIC & SEPTIC SHOCK

WHO statistics 80% of all maternal deaths are: Severe bleeding (mostly bleeding after childbirth) infections (usually after childbirth) pre-eclampsia and eclampsia unsafe abortion

introduction Definition of SIRS: clinical syndrome characterized by systemic response due to infectious or non-infectious causes

introduction Definition of sepsis: clinical syndrome characterized by systemic inflammation due to infection

introduction sepsis associated with tissue Definition of severe sepsis: sepsis associated with tissue hypoperfusion (eg,↑ lactate, oliguria) or organ dysfunction (↑creatinine,DIC, ↑BilR,GCS changes,↓plt, ↓Pao2/Fio2 )

introduction Definition of septic shock: type of vasodilatory or distributive shock that includes patients who fulfill the criteria for sepsis and despite adequate fluid resuscitation, require vasopressors to maintain a mean arterial pressure (MAP) ≥65 mmHg and have a lactate >2 mmol/L (>18 mg/dL).

diagnosis Symptoms & signs related to an infectious source T>38.3 or <36 HR>90 SBP<90 ,MAP<70 RR>20 Pao2/Fio2 < 300 Cr rise> 0.5mg/dl U/O <0.5 cc /kg /hr WBC>12000 or <4000 or band cell>10%

diagnosis BS > 140 without DM INR>1.5 or PTT >60 PLT <100000 Total BilR > 4 ↑ K ,↓ Na Lactat>2mmol/lit PCT>2 SD above ULN CRP>2 SD above ULN Mental status changes ILeus

Risk factors

Suspected sourses Genital tract Mastitis urinary tract infection Respiratory tract skin and soft-tissue infection GI tract Pharyngitis brain

Management immediate evaluation & management HX , VS , GA Thinking immediate evaluation & management HX , VS , GA Thinking VE(CMT,malodor discharge,ROM,…) AE Review of all systems to find source LAB Q6 h Imaging if indicated

Management Securing air way,correcting hypoxemia Venus access Securing air way,correcting hypoxemia Venus access Early administration of crystalloid 30cc/kg in first 3h Early administration of AB(1n first 1-6h) GC in septic shock resistant to fluid, vasopressors

Management Total GOAL Duration of IV AB : 7-10d Scvo2>70% Duration of IV AB : 7-10d Total GOAL Scvo2>70% U/O > 0.5cc/kg/h MAP >65 CVP:8-12

THANKS