Early Goal Directed Therapy for Sepsis During Pregnancy

Sepsis in Pregnancy: Some Old verses New Inclusions

“…The increased blood volume may mask cardiovascular signs in early sepsis. 9 Sepsisinduced anaerobic metabolism and lactic acidosis can cause profound tachypnoea, but an increase in respiratory rate may be potentially mistaken for the progesterone-induced hyperventilation of pregnancy.…”

Maternal Sepsis in Intensive Care Unit at Omdurman New Hospital-Tertiary Obstetric Facility, Khartoum-Sudan

“…They are further influenced by conditions associated with intrapartum and postpartum blood loss, infections such as chorioamnionitis, endometritis, pneumonia, pyelonephritis, fluids usage, medications, delivery mode, and anesthesia. These factors influence vital signs and laboratory evaluations and make accurate diagnosis of severe sepsis and septic shock more difficult in obstetric patient, particularly during labor because heart and respira-tory rates increase [3].…”

“…During a consensus conference conducted by the Society of Critical Care Medicine in 1992, the systemic inflammatory response syndrome (SIRS) was defined as a disseminated organic inflammatory response to various types of insult characterized by the presence of at least two of the following criteria: fever or hypothermia (body temperature >38˚C or <36˚C), tachycardia (heart rate >90 bpm), tachypnea (respiratory rate >20 breaths per minute or arterial carbon dioxide tension-PaCO 2 < 32 mmHg), and leukocytosis or leukopenia (white blood cell count >12,000/mm 3 or <4000/mm 3 or >10% of immature forms). In turn, sepsis was defined as SIRS associated with the presence of an infection source.…”

Sepsis in pregnancy and early goal-directed therapy

“…10 A baroreceptor-mediated increase in heart rate due to the relative hypovolaemia is exacerbated by cardiac under filling, adrenergic stimulation and fever. 9,11 Tachycardia in the presence of decreased SVR increases CO. Vasoconstrictive hormones, such as vasopressin and endothelin, are released and the reninangiotensin -aldosterone system is activated in an attempt to maintain vascular tone and intravascular volume. 11 Increased capillary permeability and venodilation decrease venous return, which combined with myocardial depression reduces stroke volume and ejection fraction in the early stages of sepsis.…”

“…45,46 This is of concern during pregnancy and the early puerperium because of the risks of obstetric haemorrhage, making rhAPC relatively contraindicated near delivery. 11 The risk of teratogenicity has been raised but placental transfer of APC appears unlikely given its molecular weight of 56 kDa, which is too large for passive diffusion. 48 There are few case reports but successful outcomes for both mother and baby after rhAPC have been reported in at least two cases of severe sepsis with a high risk of death.…”