SlideShare a Scribd company logo

Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptx

Niranjan Chavan
Niranjan Chavan
Niranjan ChavanPresently Professor and Unit Chief , Dept. Of Gynecology and Obstetrics. at LTMM College and Sion Hospital, Mumbai, India- 400022

Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.

Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptx

1 of 48
Download to read offline
GUIDELINES AND IDENTIFICATION OF
EARLY SEPSIS
32nd ANNUAL POGS CONFERENCE
CRITICAL CARE IN OBGYN
SYMBIOSIS VISHWABHAVAN, PUNE
2nd DECEMBER 2023
Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital
President, MOGS (2022-2023)
Joint Treasurer, FOGSI (2021-2025)
Organising Secretary, AICOG Mumbai 2025
Treasurer, AFG (2023-2024)
Member Oncology Committee, SAFOG (2021-2023)
Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses
Editor-in-Chief, FEMAS, JGOG & TOA Journal
68 publications in International and National Journals with 177 Citations
National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2022)
Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16)
Member, Oncology Committee AOFOG (2013-2015)
Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at
L.T.M.G.H (2010-16)
Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023)
Editorial Board, European Journal of Gynaec. Oncology (Italy)
Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS)
at LTMGH (2018-19)
DR. NIRANJAN CHAVAN
MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP,
DIPLOMA IN ENDOSCOPY (USA)
ANY INFECTION
CAN LEAD TO SEPSIS
SEPSIS IS A LEADING
CAUSE OF DEATH
MORTALITY INCREASES
EVERY HOUR IF TREATMENT
IS DELAYED
• Maternal sepsis, the third most common
direct cause of maternal mortality,
accounting for 11% of maternal deaths
worldwide.
• Undetected or poorly managed maternal
infections can lead to sepsis, death or
disability for the mother.
• Increased likelihood of Early neonatal
infection and other adverse outcomes.
Haemorrhage
27%
Sepsis11%
Hypertensive
disorders14%
Obstructed
labour9%
Abortion8%
Others31%
Source- WHO 2014
INTRODUCTION
• In low- and middle-income countries, rates of fatality
after puerperal infection can be as high as 50%.
• Under new sepsis definitions some representative reports
gave ranges on the mortality of sepsis in the general
population of 25%–30%.
• The mortality range for septic shock was 40%–70%.
SEPSIS - CONTROVERSIES AND
LIMITATIONS
• There are inherent challenges in defining Sepsis
and Septic Shock.
• First is a broad term applied to a ill understood
process.
• There are yet no simple clinical criteria or
biological, imaging or laboratory features
that can identify a septic patient.
Ad

Recommended

ObstetricSepsisBundleApproach.pptx
ObstetricSepsisBundleApproach.pptxObstetricSepsisBundleApproach.pptx
ObstetricSepsisBundleApproach.pptxNiranjan Chavan
 
Maternal Sepsis June 2 2016
Maternal Sepsis June 2 2016Maternal Sepsis June 2 2016
Maternal Sepsis June 2 2016cmfarrell
 
Recurrent uti in pregnancy
Recurrent uti in pregnancyRecurrent uti in pregnancy
Recurrent uti in pregnancyNiranjan Chavan
 
Gestational trophoblastic disease-Hamisi Mkindi
Gestational trophoblastic disease-Hamisi Mkindi Gestational trophoblastic disease-Hamisi Mkindi
Gestational trophoblastic disease-Hamisi Mkindi Mkindi Mkindi
 
Chickengunia in pregnancy by dr alka & dr apurva mukherjee nagpur m.s. india
Chickengunia in pregnancy by dr alka & dr  apurva mukherjee nagpur m.s. indiaChickengunia in pregnancy by dr alka & dr  apurva mukherjee nagpur m.s. india
Chickengunia in pregnancy by dr alka & dr apurva mukherjee nagpur m.s. indiaalka mukherjee
 

More Related Content

Similar to Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptx

( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...
( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...
( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...Abdullatif Al-Rashed
 
Palm coein clasification
Palm coein clasificationPalm coein clasification
Palm coein clasificationnermine amin
 
SURVIVING SEPSIS CAMPAIGN- 2012 to 2016
SURVIVING SEPSIS CAMPAIGN- 2012 to 2016SURVIVING SEPSIS CAMPAIGN- 2012 to 2016
SURVIVING SEPSIS CAMPAIGN- 2012 to 2016Rahul Goel
 
Sepsis, Septic Shock and Surviving Sepsis Guidelines
Sepsis, Septic Shock and Surviving Sepsis GuidelinesSepsis, Septic Shock and Surviving Sepsis Guidelines
Sepsis, Septic Shock and Surviving Sepsis GuidelinesNoorulhaque Shaikh
 
Neonatal sepsis
Neonatal sepsisNeonatal sepsis
Neonatal sepsisdrskverma2
 
Basic laboratory procedures in clinical bacteriology
Basic laboratory procedures in clinical bacteriologyBasic laboratory procedures in clinical bacteriology
Basic laboratory procedures in clinical bacteriologyamin beni
 
Laboratory Tests and Diagnostic Procedures.pptx
Laboratory Tests and Diagnostic Procedures.pptxLaboratory Tests and Diagnostic Procedures.pptx
Laboratory Tests and Diagnostic Procedures.pptxZaiSB
 
03. appendicitis dr phillip bmc
03. appendicitis dr phillip bmc03. appendicitis dr phillip bmc
03. appendicitis dr phillip bmcSadru mohamed
 
Clinical laboratory test interpretation
Clinical laboratory test interpretationClinical laboratory test interpretation
Clinical laboratory test interpretationSmita Jain
 
diagnosis and medical management of GUTB
diagnosis and medical management of GUTBdiagnosis and medical management of GUTB
diagnosis and medical management of GUTBGovtRoyapettahHospit
 
Prevention and management of Sepsis in Obstetrics and Gynecology
Prevention and management of Sepsis in Obstetrics and GynecologyPrevention and management of Sepsis in Obstetrics and Gynecology
Prevention and management of Sepsis in Obstetrics and GynecologyNiranjan Chavan
 
GYNAE bleeding in a early pregnancy.docx
GYNAE  bleeding in a early pregnancy.docxGYNAE  bleeding in a early pregnancy.docx
GYNAE bleeding in a early pregnancy.docxchristinetoywa
 
Hydatid cyst theva
Hydatid cyst thevaHydatid cyst theva
Hydatid cyst thevaTheva Thy
 
Antimicrobial prophylaxis in UTI - an overview of the evidence
Antimicrobial prophylaxis in UTI - an overview of the evidenceAntimicrobial prophylaxis in UTI - an overview of the evidence
Antimicrobial prophylaxis in UTI - an overview of the evidenceAnahita Sharma
 
Acute cholecystitis:Severity assessment and management
Acute cholecystitis:Severity assessment and managementAcute cholecystitis:Severity assessment and management
Acute cholecystitis:Severity assessment and managementKETAN VAGHOLKAR
 

Similar to Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptx (20)

( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...
( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...
( Journal Club ) Procalcitonin as a diagnostic biomarker of sepsis: A tertiar...
 
Palm coein clasification
Palm coein clasificationPalm coein clasification
Palm coein clasification
 
SURVIVING SEPSIS CAMPAIGN- 2012 to 2016
SURVIVING SEPSIS CAMPAIGN- 2012 to 2016SURVIVING SEPSIS CAMPAIGN- 2012 to 2016
SURVIVING SEPSIS CAMPAIGN- 2012 to 2016
 
Sepsis, Septic Shock and Surviving Sepsis Guidelines
Sepsis, Septic Shock and Surviving Sepsis GuidelinesSepsis, Septic Shock and Surviving Sepsis Guidelines
Sepsis, Septic Shock and Surviving Sepsis Guidelines
 
Neonatal sepsis
Neonatal sepsisNeonatal sepsis
Neonatal sepsis
 
Basic laboratory procedures in clinical bacteriology
Basic laboratory procedures in clinical bacteriologyBasic laboratory procedures in clinical bacteriology
Basic laboratory procedures in clinical bacteriology
 
Laboratory Tests and Diagnostic Procedures.pptx
Laboratory Tests and Diagnostic Procedures.pptxLaboratory Tests and Diagnostic Procedures.pptx
Laboratory Tests and Diagnostic Procedures.pptx
 
03. appendicitis dr phillip bmc
03. appendicitis dr phillip bmc03. appendicitis dr phillip bmc
03. appendicitis dr phillip bmc
 
Clinical laboratory test interpretation
Clinical laboratory test interpretationClinical laboratory test interpretation
Clinical laboratory test interpretation
 
Sbp
SbpSbp
Sbp
 
diagnosis and medical management of GUTB
diagnosis and medical management of GUTBdiagnosis and medical management of GUTB
diagnosis and medical management of GUTB
 
Prevention and management of Sepsis in Obstetrics and Gynecology
Prevention and management of Sepsis in Obstetrics and GynecologyPrevention and management of Sepsis in Obstetrics and Gynecology
Prevention and management of Sepsis in Obstetrics and Gynecology
 
GYNAE bleeding in a early pregnancy.docx
GYNAE  bleeding in a early pregnancy.docxGYNAE  bleeding in a early pregnancy.docx
GYNAE bleeding in a early pregnancy.docx
 
Overview of Recurrent Pregnancy Loss
Overview of Recurrent Pregnancy LossOverview of Recurrent Pregnancy Loss
Overview of Recurrent Pregnancy Loss
 
Hydatid cyst theva
Hydatid cyst thevaHydatid cyst theva
Hydatid cyst theva
 
Antimicrobial prophylaxis in UTI - an overview of the evidence
Antimicrobial prophylaxis in UTI - an overview of the evidenceAntimicrobial prophylaxis in UTI - an overview of the evidence
Antimicrobial prophylaxis in UTI - an overview of the evidence
 
Nec by Dr Achumie
Nec by Dr AchumieNec by Dr Achumie
Nec by Dr Achumie
 
Acute cholecystitis:Severity assessment and management
Acute cholecystitis:Severity assessment and managementAcute cholecystitis:Severity assessment and management
Acute cholecystitis:Severity assessment and management
 
SEPSIS.pptx
SEPSIS.pptxSEPSIS.pptx
SEPSIS.pptx
 
Maternal mortality
Maternal mortalityMaternal mortality
Maternal mortality
 

More from Niranjan Chavan

Dr. NN Chavan Keynote address on ADNEXAL MASS- APPROACH TO MANAGEMENT in the...
Dr. NN Chavan Keynote address on ADNEXAL MASS-  APPROACH TO MANAGEMENT in the...Dr. NN Chavan Keynote address on ADNEXAL MASS-  APPROACH TO MANAGEMENT in the...
Dr. NN Chavan Keynote address on ADNEXAL MASS- APPROACH TO MANAGEMENT in the...Niranjan Chavan
 
Optimising Delivery Of 1kg Fetus - Special Considerations.pptx
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxOptimising Delivery Of 1kg Fetus - Special Considerations.pptx
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
 
Seminar on FIBROIDS by Dr. N.N. Chavan Unit.pptx
Seminar on FIBROIDS by Dr. N.N. Chavan Unit.pptxSeminar on FIBROIDS by Dr. N.N. Chavan Unit.pptx
Seminar on FIBROIDS by Dr. N.N. Chavan Unit.pptxNiranjan Chavan
 
Anemia is a condition in which the number of red blood cells and/OR their oxy...
Anemia is a condition in which the number of red blood cells and/OR their oxy...Anemia is a condition in which the number of red blood cells and/OR their oxy...
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
 
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
 
SURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptx
SURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptxSURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptx
SURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptxNiranjan Chavan
 
Malignant ovarian tumors DR NN CHAVAN 19102023 .pptx
Malignant ovarian tumors DR NN CHAVAN 19102023 .pptxMalignant ovarian tumors DR NN CHAVAN 19102023 .pptx
Malignant ovarian tumors DR NN CHAVAN 19102023 .pptxNiranjan Chavan
 
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptx
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxPAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptx
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
 
Respiratory Disorders In Pregnancy 26092023.pptx
Respiratory Disorders In Pregnancy 26092023.pptxRespiratory Disorders In Pregnancy 26092023.pptx
Respiratory Disorders In Pregnancy 26092023.pptxNiranjan Chavan
 
VACCINATION IN PREGNANCY 25092023.pptx
VACCINATION IN PREGNANCY 25092023.pptxVACCINATION IN PREGNANCY 25092023.pptx
VACCINATION IN PREGNANCY 25092023.pptxNiranjan Chavan
 
DR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptx
DR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptxDR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptx
DR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptxNiranjan Chavan
 
Why Wound Gape ? - Optimising Post Surgical Wound Healing
Why Wound Gape ? - Optimising Post Surgical Wound HealingWhy Wound Gape ? - Optimising Post Surgical Wound Healing
Why Wound Gape ? - Optimising Post Surgical Wound HealingNiranjan Chavan
 
PLACENTA ACCRETA SPECTRUM DISORDERS.pptx
PLACENTA ACCRETA SPECTRUM DISORDERS.pptxPLACENTA ACCRETA SPECTRUM DISORDERS.pptx
PLACENTA ACCRETA SPECTRUM DISORDERS.pptxNiranjan Chavan
 
NUTRITION IN PREGNANCY.pptx
NUTRITION IN PREGNANCY.pptxNUTRITION IN PREGNANCY.pptx
NUTRITION IN PREGNANCY.pptxNiranjan Chavan
 
22062023 Endometrial cancer risk factors all must know.pptx
22062023 Endometrial cancer risk factors all must know.pptx22062023 Endometrial cancer risk factors all must know.pptx
22062023 Endometrial cancer risk factors all must know.pptxNiranjan Chavan
 
Recent advances in adhesion prevention post laparoscopic surgery.pptx
Recent advances in adhesion prevention post laparoscopic surgery.pptxRecent advances in adhesion prevention post laparoscopic surgery.pptx
Recent advances in adhesion prevention post laparoscopic surgery.pptxNiranjan Chavan
 
Surgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptx
Surgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptxSurgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptx
Surgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptxNiranjan Chavan
 
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptx
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptxDilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptx
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptxNiranjan Chavan
 
Endocrinological Markers in Gynaecological Tumours.pptx
Endocrinological Markers in Gynaecological Tumours.pptxEndocrinological Markers in Gynaecological Tumours.pptx
Endocrinological Markers in Gynaecological Tumours.pptxNiranjan Chavan
 

More from Niranjan Chavan (20)

Dr. NN Chavan Keynote address on ADNEXAL MASS- APPROACH TO MANAGEMENT in the...
Dr. NN Chavan Keynote address on ADNEXAL MASS-  APPROACH TO MANAGEMENT in the...Dr. NN Chavan Keynote address on ADNEXAL MASS-  APPROACH TO MANAGEMENT in the...
Dr. NN Chavan Keynote address on ADNEXAL MASS- APPROACH TO MANAGEMENT in the...
 
Optimising Delivery Of 1kg Fetus - Special Considerations.pptx
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxOptimising Delivery Of 1kg Fetus - Special Considerations.pptx
Optimising Delivery Of 1kg Fetus - Special Considerations.pptx
 
Seminar on FIBROIDS by Dr. N.N. Chavan Unit.pptx
Seminar on FIBROIDS by Dr. N.N. Chavan Unit.pptxSeminar on FIBROIDS by Dr. N.N. Chavan Unit.pptx
Seminar on FIBROIDS by Dr. N.N. Chavan Unit.pptx
 
Anemia is a condition in which the number of red blood cells and/OR their oxy...
Anemia is a condition in which the number of red blood cells and/OR their oxy...Anemia is a condition in which the number of red blood cells and/OR their oxy...
Anemia is a condition in which the number of red blood cells and/OR their oxy...
 
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...
 
SURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptx
SURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptxSURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptx
SURGICAL MANAGEMENT OF CERVICAL CANCER DR. NN CHAVAN 28102023.pptx
 
Malignant ovarian tumors DR NN CHAVAN 19102023 .pptx
Malignant ovarian tumors DR NN CHAVAN 19102023 .pptxMalignant ovarian tumors DR NN CHAVAN 19102023 .pptx
Malignant ovarian tumors DR NN CHAVAN 19102023 .pptx
 
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptx
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxPAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptx
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptx
 
Respiratory Disorders In Pregnancy 26092023.pptx
Respiratory Disorders In Pregnancy 26092023.pptxRespiratory Disorders In Pregnancy 26092023.pptx
Respiratory Disorders In Pregnancy 26092023.pptx
 
VACCINATION IN PREGNANCY 25092023.pptx
VACCINATION IN PREGNANCY 25092023.pptxVACCINATION IN PREGNANCY 25092023.pptx
VACCINATION IN PREGNANCY 25092023.pptx
 
DR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptx
DR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptxDR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptx
DR.NNC INVASIVE CERVICAL CARCINOMA 20092023.pptx
 
Why Wound Gape ? - Optimising Post Surgical Wound Healing
Why Wound Gape ? - Optimising Post Surgical Wound HealingWhy Wound Gape ? - Optimising Post Surgical Wound Healing
Why Wound Gape ? - Optimising Post Surgical Wound Healing
 
PLACENTA ACCRETA SPECTRUM DISORDERS.pptx
PLACENTA ACCRETA SPECTRUM DISORDERS.pptxPLACENTA ACCRETA SPECTRUM DISORDERS.pptx
PLACENTA ACCRETA SPECTRUM DISORDERS.pptx
 
NUTRITION IN PREGNANCY.pptx
NUTRITION IN PREGNANCY.pptxNUTRITION IN PREGNANCY.pptx
NUTRITION IN PREGNANCY.pptx
 
22062023 Endometrial cancer risk factors all must know.pptx
22062023 Endometrial cancer risk factors all must know.pptx22062023 Endometrial cancer risk factors all must know.pptx
22062023 Endometrial cancer risk factors all must know.pptx
 
Recent advances in adhesion prevention post laparoscopic surgery.pptx
Recent advances in adhesion prevention post laparoscopic surgery.pptxRecent advances in adhesion prevention post laparoscopic surgery.pptx
Recent advances in adhesion prevention post laparoscopic surgery.pptx
 
Surgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptx
Surgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptxSurgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptx
Surgical Management of Cervical Cancer 11052023 FOGSI PAC LECTURE WEBINAR.pptx
 
AI in Gynaec Onco
AI in Gynaec OncoAI in Gynaec Onco
AI in Gynaec Onco
 
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptx
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptxDilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptx
Dilemmas in Diagnosis and Management of FGR Dr NNC 06082022.pptx
 
Endocrinological Markers in Gynaecological Tumours.pptx
Endocrinological Markers in Gynaecological Tumours.pptxEndocrinological Markers in Gynaecological Tumours.pptx
Endocrinological Markers in Gynaecological Tumours.pptx
 

Recently uploaded

The Institutional Origins of Canada’s Telecommunications Mosaic
The Institutional Origins of Canada’s Telecommunications MosaicThe Institutional Origins of Canada’s Telecommunications Mosaic
The Institutional Origins of Canada’s Telecommunications MosaicUniversity of Canberra
 
LOGISTICS AND SUPPLY CHAIN MANAGEMENT
LOGISTICS  AND  SUPPLY CHAIN  MANAGEMENTLOGISTICS  AND  SUPPLY CHAIN  MANAGEMENT
LOGISTICS AND SUPPLY CHAIN MANAGEMENThpirrjournal
 
Exit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docxExit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docxMYDA ANGELICA SUAN
 
Practical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptxPractical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptxKatherine Villaluna
 
UNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATION
UNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATIONUNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATION
UNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATIONSayali Powar
 
2.15.24 Making Whiteness -- Baldwin.pptx
2.15.24 Making Whiteness -- Baldwin.pptx2.15.24 Making Whiteness -- Baldwin.pptx
2.15.24 Making Whiteness -- Baldwin.pptxMaryPotorti1
 
ACTIVIDAD DE CLASE No 1 - SOPA DE LETRAS
ACTIVIDAD DE CLASE No 1 - SOPA DE LETRASACTIVIDAD DE CLASE No 1 - SOPA DE LETRAS
ACTIVIDAD DE CLASE No 1 - SOPA DE LETRASMaria Lucia Céspedes
 
Appendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptxAppendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptxRenuka N Sunagad
 
Different types of animal Tissues DMLT .pptx
Different types of animal Tissues DMLT .pptxDifferent types of animal Tissues DMLT .pptx
Different types of animal Tissues DMLT .pptxPunamSahoo3
 
The Ministry of Utmost Happiness by Arundhati Roy
The Ministry of Utmost Happiness by Arundhati RoyThe Ministry of Utmost Happiness by Arundhati Roy
The Ministry of Utmost Happiness by Arundhati RoyTrushali Dodiya
 
EDL 290F Week 1 - Meet Me at the Start Line.pdf
EDL 290F Week 1 - Meet Me at the Start Line.pdfEDL 290F Week 1 - Meet Me at the Start Line.pdf
EDL 290F Week 1 - Meet Me at the Start Line.pdfElizabeth Walsh
 
2.15.24 The Birmingham Campaign and MLK.pptx
2.15.24 The Birmingham Campaign and MLK.pptx2.15.24 The Birmingham Campaign and MLK.pptx
2.15.24 The Birmingham Campaign and MLK.pptxMaryPotorti1
 
Uncovering Consumers’ Hidden Narratives
Uncovering Consumers’ Hidden NarrativesUncovering Consumers’ Hidden Narratives
Uncovering Consumers’ Hidden NarrativesRay Poynter
 
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdfWriting Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdfMr Bounab Samir
 
John See - Narrative Story
John See - Narrative StoryJohn See - Narrative Story
John See - Narrative StoryAlan See
 
LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)
LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)
LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)satyanshp7890
 
Website Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online PresenceWebsite Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online PresenceSamantha Russell
 
Cardiovascular Pathophysiology- Hypertension
Cardiovascular Pathophysiology- HypertensionCardiovascular Pathophysiology- Hypertension
Cardiovascular Pathophysiology- HypertensionVISHALJADHAV100
 
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptxPractical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptxKatherine Villaluna
 

Recently uploaded (20)

The Institutional Origins of Canada’s Telecommunications Mosaic
The Institutional Origins of Canada’s Telecommunications MosaicThe Institutional Origins of Canada’s Telecommunications Mosaic
The Institutional Origins of Canada’s Telecommunications Mosaic
 
Caldecott Medal Book Winners and Media Used
Caldecott Medal Book Winners and Media UsedCaldecott Medal Book Winners and Media Used
Caldecott Medal Book Winners and Media Used
 
LOGISTICS AND SUPPLY CHAIN MANAGEMENT
LOGISTICS  AND  SUPPLY CHAIN  MANAGEMENTLOGISTICS  AND  SUPPLY CHAIN  MANAGEMENT
LOGISTICS AND SUPPLY CHAIN MANAGEMENT
 
Exit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docxExit Essay - Save the Filipino Language by Renz Perez.docx
Exit Essay - Save the Filipino Language by Renz Perez.docx
 
Practical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptxPractical Research 1: Nature of Inquiry and Research.pptx
Practical Research 1: Nature of Inquiry and Research.pptx
 
UNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATION
UNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATIONUNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATION
UNIT 1 BIOMOLECULE_CARBOHYDRATES PRESENTATION
 
2.15.24 Making Whiteness -- Baldwin.pptx
2.15.24 Making Whiteness -- Baldwin.pptx2.15.24 Making Whiteness -- Baldwin.pptx
2.15.24 Making Whiteness -- Baldwin.pptx
 
ACTIVIDAD DE CLASE No 1 - SOPA DE LETRAS
ACTIVIDAD DE CLASE No 1 - SOPA DE LETRASACTIVIDAD DE CLASE No 1 - SOPA DE LETRAS
ACTIVIDAD DE CLASE No 1 - SOPA DE LETRAS
 
Appendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptxAppendicular SkeletonSystem PPT.....pptx
Appendicular SkeletonSystem PPT.....pptx
 
Different types of animal Tissues DMLT .pptx
Different types of animal Tissues DMLT .pptxDifferent types of animal Tissues DMLT .pptx
Different types of animal Tissues DMLT .pptx
 
The Ministry of Utmost Happiness by Arundhati Roy
The Ministry of Utmost Happiness by Arundhati RoyThe Ministry of Utmost Happiness by Arundhati Roy
The Ministry of Utmost Happiness by Arundhati Roy
 
EDL 290F Week 1 - Meet Me at the Start Line.pdf
EDL 290F Week 1 - Meet Me at the Start Line.pdfEDL 290F Week 1 - Meet Me at the Start Line.pdf
EDL 290F Week 1 - Meet Me at the Start Line.pdf
 
2.15.24 The Birmingham Campaign and MLK.pptx
2.15.24 The Birmingham Campaign and MLK.pptx2.15.24 The Birmingham Campaign and MLK.pptx
2.15.24 The Birmingham Campaign and MLK.pptx
 
Uncovering Consumers’ Hidden Narratives
Uncovering Consumers’ Hidden NarrativesUncovering Consumers’ Hidden Narratives
Uncovering Consumers’ Hidden Narratives
 
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdfWriting Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
Writing Agony Letter & If type O+1 & Diphthongs + Text “Arab Science”.pdf
 
John See - Narrative Story
John See - Narrative StoryJohn See - Narrative Story
John See - Narrative Story
 
LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)
LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)
LIGHT,MIRROR,REFLECTION& REFRACTION. (Optometric optics)
 
Website Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online PresenceWebsite Fixer-Upper Series to Boost your Online Presence
Website Fixer-Upper Series to Boost your Online Presence
 
Cardiovascular Pathophysiology- Hypertension
Cardiovascular Pathophysiology- HypertensionCardiovascular Pathophysiology- Hypertension
Cardiovascular Pathophysiology- Hypertension
 
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptxPractical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
Practical Research 1: Qualitative Research and Its Importance in Daily Life.pptx
 

Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptx

  • 1. GUIDELINES AND IDENTIFICATION OF EARLY SEPSIS 32nd ANNUAL POGS CONFERENCE CRITICAL CARE IN OBGYN SYMBIOSIS VISHWABHAVAN, PUNE 2nd DECEMBER 2023
  • 2. Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H, Sion Hospital President, MOGS (2022-2023) Joint Treasurer, FOGSI (2021-2025) Organising Secretary, AICOG Mumbai 2025 Treasurer, AFG (2023-2024) Member Oncology Committee, SAFOG (2021-2023) Dean AGOG & Chief Content Director, HIGHGRAD & FEMAS Courses Editor-in-Chief, FEMAS, JGOG & TOA Journal 68 publications in International and National Journals with 177 Citations National Coordinator, FOGSI Medical Disorders in Pregnancy Committee (2019-2022) Chair & Convener, FOGSI Cell Violence Against Doctors (2015-16) Member, Oncology Committee AOFOG (2013-2015) Coordinator of 11 batches of MUHS recognized Certificate Course of B.I.M.I.E at L.T.M.G.H (2010-16) Member, Managing Committee IAGE (2013-17), (2018-20), (2022-2023) Editorial Board, European Journal of Gynaec. Oncology (Italy) Course Coordinator of 3 batches of Advanced Minimal Access Gynaec Surgery (AMAS) at LTMGH (2018-19) DR. NIRANJAN CHAVAN MD, FCPS, DGO, MICOG, DICOG, FICOG, DFP, DIPLOMA IN ENDOSCOPY (USA)
  • 3. ANY INFECTION CAN LEAD TO SEPSIS SEPSIS IS A LEADING CAUSE OF DEATH MORTALITY INCREASES EVERY HOUR IF TREATMENT IS DELAYED
  • 4. • Maternal sepsis, the third most common direct cause of maternal mortality, accounting for 11% of maternal deaths worldwide. • Undetected or poorly managed maternal infections can lead to sepsis, death or disability for the mother. • Increased likelihood of Early neonatal infection and other adverse outcomes. Haemorrhage 27% Sepsis11% Hypertensive disorders14% Obstructed labour9% Abortion8% Others31% Source- WHO 2014 INTRODUCTION
  • 5. • In low- and middle-income countries, rates of fatality after puerperal infection can be as high as 50%. • Under new sepsis definitions some representative reports gave ranges on the mortality of sepsis in the general population of 25%–30%. • The mortality range for septic shock was 40%–70%.
  • 6. SEPSIS - CONTROVERSIES AND LIMITATIONS • There are inherent challenges in defining Sepsis and Septic Shock. • First is a broad term applied to a ill understood process. • There are yet no simple clinical criteria or biological, imaging or laboratory features that can identify a septic patient.
  • 7. • Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or postpartum period (WHO). DEFINITION
  • 9. Dr Komal N. Chavan, Mumbai
  • 10. CAUSES OF SEPSIS Obstetric causes: • Retained product of conception (septic abortion, retained placenta) • Chorioamnionitis • Endometritis pelvic abscess and • Wound infection Non Obstetric causes: • Pyelonephritis • Appendicitis • Bowel infarction • Pancreatitis and pneumonia (bacterial as staphylococcus or pneumococcus) or • Viral (H1 N1,influenza, Herpes)
  • 12. THE MOST COMMON INFECTIOUS ETIOLOGIES OF SEPSIS Source of infection Pelvic intrapartum postpartum Non pelvic antepartum • The causative microorganism can be identified in 64% . • The source of infection can be identified in 74%. • In 16%, neither the inciting organism nor the source of sepsis can be identified. • Escherichia coli and group A and group B Streptococcus • Staphylococci, gram-negative and anaerobic bacteria. • Mixed infections are also possible. • 15% of maternal sepsis deaths in which organisms could be identified, the infection was polymicrobial.
  • 13. TYPES OF INFECTION Infection Features 1. Infected wound ( perineal or abdominal) Discharge from wound, pain, erythema and swelling around wound, wound dehiscence, burst abdomen 2. Endometritis /septic abortion Abdominal pain, vaginal bleeding, offensive cervical discharge, uterine tenderness, delayed uterine involution, fever 3. Chorioamnionitis Abdominal pain, vaginal bleeding, offensive vaginal discharge or lochia, uterine tenderness, delayed uterine involution, fetal tachycardia >160 beats per minute, fever 4. Respiratory tract infection Productive cough, sore throat, shortness of breath/difficulty breathing, chest pain and fever 5. Breast abscess/mastitis Breast pain and tenderness, erythema, painful induration, nipple discharge
  • 14. 6. Urinary tract infection Dysuria, increased frequency, urgency, abdominal/flank/back pain, rigors, fever, nausea and vomiting 7. Malaria Fever, headache, muscle/joint pain, jaundice, anemia 8. Meningitis Headache, rash, photophobia, neck stiffness, confusion, fever, nausea and vomiting 9. Toxic shock syndrome (streptococcal and staphylococcal) Nausea, vomiting, diarrhea, watery vaginal discharge, generalized maculopapular rash, conjunctival suffusion 10.Non-specific features of infection Lethargy, reduced appetite, fever, nausea, vomiting
  • 15. Infected Abdominal Wound Endometritis Respiratory Tract infection
  • 16. Breast Abcess Meningitis Toxic Shock Syndrome
  • 17. PATHOPHYSIOLOGY Infection Inflammatory response Extravasation of albumin and fluid Organ dysfunction Cytokines Decreased Systemic Vascular Resistance & increased Colloid Oncotic Pressure Dysregulated Host Response Hypovolemia Septic Cardiomyopathy Pulmonary Oedema and Hypotension
  • 19. CLINICALAND LABORATORY DIAGNOSIS OF SEPSIS Signs and Symptoms: • Fever or Temperature instability(>380 C or 110 beats/min) * • Tachypnea (>24 breaths/min) • Diaphoresis • Clammy or mottled skin • Nausea or vomiting • Hypotension or shock • Oliguria or anuria • Pain (location based on site of infection) • Altered mental state (confusion, decreased alertness) Laboratory Findings: • Leukocytosis or leukopenia • Positive culture from infection site and/or blood • Hypoxemia • Thrombocytopenia • Metabolic acidosis: Increase serum lactate, low arterial pH, base deficit • Elevated serum creatinine • Elevated liver enzymes • Hyperglycemia in the absence of diabetes • Disseminated intravascular coagulation
  • 22. • The best tool for identifying infection or predicting mortality in pregnant or postpartum patients remains unknown. • But simple bedside screening tool such as the SOS, MEOWS or OMSOFA, followed by further evaluation for evidence of end-organ damage are used for early recognition of sepsis.
  • 23. Dr Komal N. Chavan, Mumbai Adv Excellent Negative Predictive Value 98.6% Rapidly rules out need for ICU Does not use altered mental status in criteria Disadv Complex scoring system with multiple variables Requires laboratory data, which can delay diagnosis
  • 24. • RCOG –has recommended modified early obstetric warning score (MEOWS) to detect signs of sepsis Dr Komal N. Chavan, Mumbai Adv Simple bedside screening tool Disadv Marked variation of thresholds and formats Validated for chorioamnionitis Over detects severe sepsis Need for secondary testing to identify true- positives Low specificity.
  • 25. OBSTETRICALLY MODIFIED QUICK SEQUENTIAL ORGAN FAILURE ASSESSMENT (OMQSOFA) • Presence of 3 clinical criteria: Systolic<90mm of hg RR≥25 Altered mental status (≥ 2 of these associated with ↑ risk poor outcome) Advantage: Simple bedside screening tool Uses only clinical data, allowing for rapid diagnosis. Disadvantage: Altered mental status in criteria may have nonseptic causes in obstetric patients Need for secondary testing.
  • 27. INVESTIGATIONS • Complete blood count • Electrolytes • Blood cultures, if sepsis is suspected • Urinalysis, with cultures and sensitivity tests • Cervical or uterine cultures • Wound cultures • Lactate • Coagulation studies, if pelvic thrombosis, deep vein thrombosis, pulmonary embolism, or invasive treatment (eg, surgical procedure) is being considered • Pelvic USG- retained products of conception, pelvic abscess, or infected hematoma. • CT or MRI - septic pelvic thrombosis.
  • 28. ROLE OF BIOMARKERS • Currently no one biomarker has been identified as the gold standard. • Commonly used markers such as white cell count and C-reactive protein are neither specific nor sensitive. • Procalcitonin - guiding antibiotic therapy -shows promise, NICE guidelines- there is currently insufficient evidence. Surviving Sepsis Campaign (SSC) Guidelines- low- quality evidence to support its use. There is absence of an accepted normal range during pregnancy. • Serum lactate - is a useful biomarker, elevated lactate levels associated with poor outcomes in maternal sepsis. Repeat measurement required if initial lactate is greater than 2 mmol/L.
  • 29. Dr Komal N. Chavan, Mumbai
  • 30. EARLY SCREENING & MANAGEMENT 1. Screening and Management of Infection: The first step - cultures and blood samples followed by administering appropriate antibiotics. 2. Screening for Organ Dysfunction and Management of Sepsis : identified by the organ dysfunction criteria; omqSOFA. 3. Identification and Management of Initial Hypotension: Patients with infection and hypotension or a lactate level >4mmol/L, are given 30mL/kg crystalloid with reassessment of volume responsiveness and tissue perfusion. In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate >4mmol/l vasopressors are used. a. Achieve a central venous pressure (CVP) of ≥8mmHg . b. Achieve a central venous oxygen saturation (ScvO2 ) ≥ 70% or mixed venous oxygen saturation (ScvO2 ) ≥ 65%.
  • 31. Sepsis Six’ –A set of Six tasks including • Oxygen, • Cultures, • Antibiotics, • Fluids, • Lactate measurement and • Urine Output monitoring. • - To be instituted within one hour.
  • 33. Recognition is key Pearl 1. Always maintain a high index of suspicion for sepsis. Pearl 2. Implement a rapid bedside tool for detection of maternal deterioration. Move fast during the golden hour Pearl 3. Implement sepsis bundles to facilitate rapid escalation of care. Pearl 4. Laboratory and radiologic studies are keys to search for etiology and source control. Pearl 5. Know microbes and likely origin, and that group A streptococcus can kill quickly. Pearl 6. Choose antimicrobials tailored to the most likely diagnosis. Pearl 7. Fluid resuscitation should be initiated rapidly for patients with a blood lactate greater than 4 mmol/L or mean arterial pressure less than 65 mm Hg. Beyond the golden hour Pearl 8. Escalation of care is critical to survival. Pearl 9. Once the patient is stabilized, get to the source of the problem. Pearl 10. Anticipate and prevent adverse pregnancy outcomes. Top 10 Pearls for Managing Maternal Sepsis
  • 35. SOURCE CONTROL • Once a source of sepsis is identified, Source Control is a priority and may involve Abscess Drainage or the Delivery of the Fetus if the uterus is found to be the source of the infection.
  • 36. DELIVERY DECISION • Influenced by patient’s condition, gestational age, fetal status, presence of chorioamnionitis, and labor. • In a critically ill woman, delivery is considered if it would be beneficial to the mother or the baby or to both. • Attempting delivery of unstable mother increases the maternal and fetal mortality rates unless the source of infection is intrauterine. • Indicators of delivery are Intrauterine infection, DIC, hepatic/ renal problems, heart failure, compartmental syndrome, multifetal gestation and ARDS. While fetal factors include fetal demise and a gestationally viable fetus. • During the intrapartum period, continuous electronic fetal monitoring is recommended. • Epidural/spinal anesthesia should be avoided in women with sepsis and a general anesthetic will usually be required for caesarean section.
  • 37. ROLE OF CORTICOSTEROIDS • Corticosteroids in septic patients is subject of controversy. • Hydrocortisone – reserved for Septic Patients with Refractory Shock (those who remain hypotensive following initial fluid resuscitation and vasopressors). • IV infusion of hydrocortisone at a dose of 200mg per day. • Monitored for hyperglycemia and hypernatremia. • Must be given within the first 7 days of treatment and should be interrupted as soon as the patient shows signs of clinical improvement. • Another benefit is the need for corticoids to accelerate fetal lung maturation.
  • 38. DEEP VENOUS THROMBOSIS PROPHYLAXIS • Prevention of DVT is essential in septic pregnant patients as both Pregnancy and Sepsis are associated with hypercoagulability. • Methods of prophylaxis are the use of compression stockings, intermittent lower limb compression, and LMWH or unfractionated heparin. • The role of intravenous immunoglobulin (IVIG) : IVIG is recommended for severe invasive Streptococcal or Staphylococcal Infection if other therapies have failed because of its immunomodulatory effect.
  • 39. EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) • Respiratory failure in patients in the intensive care unit, ECMO has been used increasingly during pregnancy and the puerperium. • ECMO may be a choice for the treatment of refractory sepsis.
  • 40. SUMMARY LIST OF WHO RECOMMENDATIONS FOR PREVENTION AND TREATMENT OF MATERNAL PERIPARTUM INFECTIONS CONTEXT RECOMMENDATION
  • 41. • Routine perineal/pubic shaving prior to giving vaginal birth is not recommended. • Digital vaginal examination at intervals of four hours is recommended for routine assessment of active first stage of labour in low-risk women. • Routine vaginal cleansing with chlorhexidine during labour for the purpose of preventing infectious morbidities is not recommended. • Routine vaginal cleansing with chlorhexidine during labour in women with group B Streptococcus (GBS) colonization is not recommended for prevention of early neonatal GBS infection. • Vaginal cleansing with povidone-iodine immediately before caesarean section is recommended.
  • 42. MATERNALAND PERINATAL COMPLICATIONS OF SEVERE SEPSIS AND SEPTIC SHOCK • Pulmonary oedema and Adult respiratory distress syndrome. • Myocardial ischemia and left ventricular dysfunction. • Renal failure. • Disseminated intravascular coagulation. • Multiple organ failure is associated with a high rate of maternal mortality. • Preterm labour result of release of endotoxins. • Neonatal hypoxia, sepsis or death.
  • 44. • Physiological changes in pregnancy must be differentiated from features of sepsis. • Always maintain a high index of suspicion for sepsis. • Implement a rapid bedside tool for the detection of maternal deterioration. • The diagnosis of sepsis should be considered with otherwise unexplained end-organ damage in the presence of an infectious process, regardless of the presence of fever • Empiric broad-spectrum antibiotics be administered as soon as possible, ideally within 1 hour TAKE HOME MESSAGES
  • 45. TAKE HOME MESSAGES • Cultures (blood, urine, respiratory, and others as indicated) and serum lactate levels must be done • Early administration of 1-2 L of crystalloid solutions in sepsis complicated by hypotension or organ hypoperfusion. • Use of norepinephrine as the first-line vasopressor with persistent hypotension and/or hypoperfusion despite fluid resuscitation. • No immediate delivery for the sole indication of sepsis and that it should be dictated by obstetric indications.
  • 46. REFERENCES • Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine 1992. Chest 2009; 136 (Suppl 5): e28. • Paruk F. Infection in obstetric critical care. Best Pract Res Clin Obstet Gynaecol 2008; 22: 865–83. • Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl 1): 1–203. • Schuitemaker N, van Roosmalen J, Dekker G, van Dongen P, van Geijn H, Bennebroek Gravenhorst J. Confidential enquiry into maternal deaths in The Netherlands 1983–1992. Eur J Obstet Gynecol Reprod Biol 1998; 79: 57–62. • Zwart JJ, Dupuis JR, Richters A, Ory F, van Roosmalen J. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Intensive Care Med 2010; 36: 256– 63.
  • 47. WISE AND HUMANE MANAGEMENT OF THE PATIENT IS THE BEST SAFEGUARD AGAINST INFECTION. -NIRANJAN CHAVAN

Editor's Notes

  1. Systemic Inflammatory Response Syndrome (SIRS)
  2. Modified Early Obstetrics Warning Score (MEOWS) & Obstetrics Modified Sequential Organ Failure Assessment (OMSOFA)