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maternal sepsis
- 1. Dr.S.H.Saghaleini Anesthesiologist - Intensivist Assistant Professor of Anesthesiology Tabriz University of Medical Sciences10/15/2019 1
- 2. Why Maternal Sepsis Is Such an Important Topic? 10/15/2019 Dr.Hadi Saghaleini 2
- 3. It’s hard to imagine in this day and age that being pregnant and giving birth can result in life-threatening complications. However, this is the reality for over 60,000 women in the United States each year. About 2,000 women die and some are left with lasting and life-changing issues. 10/15/2019 Dr.Hadi Saghaleini 3
- 4. Not all complications related to pregnancy and childbirth are preventable, but some , like Sepsis may be avoided with increased sepsis awareness and quick recognition and treatment of infections 10/15/2019 Dr.Hadi Saghaleini 4
- 6. Causes Of Maternal Death In Iran Obstetric Hemorrhage Cardiac diseases Eclampsia/ Pre eclampsia /HELLP Emboli Pregnancy-related infection Others •Obstetric Hemorrhage •Cardiac diseases Eclampsia/ pre eclampsia •Emboli •Pregnancy-related infection •others 10/15/2019 Dr.Hadi Saghaleini 6
- 7. Risk Factors For Sepsis Miscarriage Abortion Invasive tests during pregnancy Cesarean section Preterm delivery Prolonged labor Ruptured membranes Postpartum hemorrhage Stillbirth Retaining placenta after birth Multiple gestation Mastitis Chronic illnesses, like diabetes 10/15/2019 Dr.Hadi Saghaleini 7
- 11. The New WHO Definition Of Maternal Sepsis Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post- abortion, or postpartum period 10/15/2019 Dr.Hadi Saghaleini 11
- 13. Maternal sepsis is the underlying cause of 11% of all maternal deaths The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality 10/15/2019 Dr.Hadi Saghaleini 13
- 14. With better identification criteria Possible severe maternal infections could be identified earlier Treatment could be implemented more promptly Maternal sepsis and other serious outcomes could be prevented 10/15/2019 Dr.Hadi Saghaleini 14
- 15. Sepsis-3 had limitations with regards to identifying sepsis related to pregnancy and childbirth Normal physiologic changes of pregnancy (hyperdynamic circulation, tachycardia, diminished oxygen reserve, hypercoagulability) overlap with dysregulated host response to infection and further challenge the identification of infections during pregnancy and early puerperium 10/15/2019 Dr.Hadi Saghaleini 15
- 16. Identify women at risk of developing complications Clinical Laboratory Management indicators (e.g. early warning systems) 10/15/2019 Dr.Hadi Saghaleini 16
- 19. Maternal Clinical Findings • Temperature instability (higher than 38.0 °C or lower than 36.0 °C) • Tachycardia (HR greater than 110) , Tachypnea (RR greater than 24) • O2 saturation, PaO2/FiO2 • Diaphoresis • Nausea or vomiting • Hypotension or shock , Decrease capillarity refill, clammy or mottled skin • Oliguria or anuria • Pain (location based on site of infection) • Altered mental state • Fetal distress (fetal tachycardia, acidosis)10/15/2019 Dr.Hadi Saghaleini 19
- 20. Identify women at risk of developing complications Clinical Laboratory Management indicators (e.g. early warning systems) 10/15/2019 Dr.Hadi Saghaleini 20
- 21. Maternal Laboratory Findings • Leucocytosis or leukopenia, immature neutrophils • Positive culture from infection site or blood • Hypoxemia • Thrombocytopenia, INR, PTT , DIC • Metabolic acidosis • Hypoperfusion, increased serum lactate • Elevated serum creatinine and urea • Elevated liver enzymes, bilirubin • Hyperglycaemia in the absence of diabetes10/15/2019 Dr.Hadi Saghaleini 21
- 26. “The best possible care of critically ill patients can be rendered when physicians of various specialties, nurses, and allied health professionals join forces and treat problems together” Ake Grenvik, MD (1974) (one of the true creators of multi-disciplinary critical care medicine) 10/15/2019 Dr.Hadi Saghaleini 26
- 28. Identify women at risk of developing complications Clinical Laboratory Management indicators (e.g. early warning systems) 10/15/2019 Dr.Hadi Saghaleini 28
- 32. Open intensive care unit model Patients are admitted under the care of an internist, family physician, surgeon, or any other primary attending physician, with the intensivists being available to provide their expertise via elective consultation The patient's primary physician determines the need for ICU admission and discharge. 10/15/2019 Dr.Hadi Saghaleini 32
- 33. Closed intensive care unit model All patients admitted to the ICU are cared for by an intensivist-led team that is responsible for making clinical decisions. The admissions and discharges are controlled by an on-site ICU physician in most closed ICU models. 10/15/2019 Dr.Hadi Saghaleini 33
- 34. Hybrid or transitional ICU or semi-closed ICU Semi-closed ICU is one in which critical care team provides direct patient care in collaboration with other 'privileged' physicians, who are also allowed to write orders. In this model, the primary treating physicians are not a part of the ICU team, but remain actively involved in their patients' care. Many surgical , maternal and cardiothoracic ICUs maintain this model. 10/15/2019 Dr.Hadi Saghaleini 34
- 36. Maternal ICU Regular On – call assured On – call if available Intensivist/critical care subspecialist 24*7 presence of anesthesiologist Nursing staff ( 1:1 or 1:2) Support staff Pharmacist Dietician Data entry operator Electrical technician security Obstetrician/ perinatologist Critical care subspecialist Surgeon Radiologist Cardiologist Nephrologist Neurologist Endocrinologist Pulmonologist 10/15/2019 Dr.Hadi Saghaleini 36