Grand Rounds: Treating septic shock in ob/gyn patients

March 1, 2005

Recognize the signs and symptoms of septic shock early on and act quickly. Doing so increases the odds of halting the progression of this infrequently encountered but life-threatening condition.

Sepsis accounts for 9.3% of deaths overall in the United States.1 The good news is that only a small percentage of these occur in ob/gyn patients, but don't let that make you complacent. In fact, most of the literature on the subject dates back to the early 1980s and earlier. Undoubtedly, the scant recent literature on managing it in the ob/gyn patient is due to the decline of septic abortion now that illegal or self-induced abortions are so rare. Although definitive management of the patient in septic shock is not part of the generalist's scope of practice, initial diagnosis, resuscitation, and surgery are often required before and during management by the appropriate subspecialist well-versed in the care of the septic, critically ill patient. Our purpose here is to define sepsis and its related syndromes, briefly look at common causes and theories about its pathophysiology, and then focus on expanded management options like goal-directed resuscitation, which is supported by recent studies.

Definitions of sepsis, septic shock The American College of Chest Physicians and the Society of Critical Care Medicine agreed upon the definitions of sepsis and its consequences at a consensus conference in 1991.2 These definitions, still in use today, are based on the understanding that these conditions reflect a common pathophysiology that differs only in degree of severity, ranging from the body's systemic response to an infection to multiorgan dysfunction with hemodynamic instability.