References:
Society for Maternal-Fetal Medicine (SMFM), Plante LA, Pacheco LD, Louis JM. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. AM J Obstet Gynecol. 2019 Jan 23.[Epub ahead of print] Available at https://www.ajog.org/article/S0002-9378(19)30246-7/fulltext. Accessed March 19, 2019.
Maternal sepsis is a significant cause of maternal morbidity and mortality. Among women who died from sepsis, a majority had a delay in care and a delay in escalation of care. These are seven recommendations to improve care of pregnant patients with sepsis.
For more information on pregnancy and sepsis: Sepsis during pregnancy and the puerperium
RECOMMENDATION
Sepsis and septic shock should be considered medical emergencies and treatment and resuscitation for sepsis should begin immediately.
GRADE
1B Strong recommendation, moderate-quality evidence
RECOMMENDATION:
Providers should consider the diagnosis of sepsis in pregnant patients with otherwise unexplained end-organ damage in the presence of an infectious process, regardless of the presence of fever.
GRADE
1B Strong recommendation, moderate-quality evidence
RECOMMENDATION
Empiric broad-spectrum antibiotics should be administered as soon as possible, ideally within 1 hour, in any pregnant woman in whom sepsis is suspected.
GRADE
1B Strong recommendation, moderate-quality evidence
RECOMMENDATION
Obtain cultures (blood, urine, respiratory, and others as indicated) and serum lactate levels in pregnant or postpartum women in whom sepsis is suspected or identified. Early source control should be completed as soon as possible.
GRADE
1C Strong recommendation, low-quality evidence
RECOMMENDATION
Administer 1 to 2 L of crystalloid solutions early in sepsis complicated by hypotensions or organ hypoperfusion.
GRADE
1C Strong recommendation, low-quality evidence
RECOMMENDATION
Norepinephrine should be the first-line vasopressor during pregnancy and the postpartum period in sepsis with persistent hypotensions and/or hypoperfusions despite fluid resuscitation.
GRADE
1C Strong recommendation, low-quality evidence
RECOMMENDATION
Immediate delivery is not recommended due to the sole indication of sepsis and that delivery should be dictated by obstetric indications.
GRADE
1B Strong recommendation, moderate-quality evidence
