10. sepsis rev 19.5.10


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10. sepsis rev 19.5.10

  1. 1. SEPSIS
  2. 2. Aims To recognise sepsis To practise an effective response to awoman with sepsis To achieve competence in those skills
  3. 3. Sepsis Major cause of maternal mortalityIn labour and Delivery: Suspect if fever, preterm labour, foulsmelling watery dischargeAfter delivery: Suspect if fever +/- offensive lochia andboggy uterus
  4. 4. Causes of fever duringpregnancy and after delivery Septic abortion Chorioamnionitis UTI (pyelonephritis) Chest infection Phlebitis Hepatitis
  5. 5. Causes of fever duringpregnancy and after delivery Puerperal sepsis (Endometritis, pelvicabscess, peritonitis) Wound infections Mastitis, breast abscess Meningitis Malaria, enteric fever
  6. 6. Recognition of Sepsis Fever: temperature > 38 oC Warm extremities Fast breathing Increased maternal and fetal heart rate Altered mental state Low BP Septic shock
  7. 7. General Management Principles ABCs If conscious, increase oral fluid intake andin all start iv fluids Treat fever Start iv antibiotics Treat underlying causes Prompt REFERAL
  8. 8. General Management Principles• Antibiotic therapy (AGM)Not Severe: oral ampicillin 1g, 80mg gentamicinIM, oral metronidazole 400mgSevere: IV ampicillin 1g stat, 80mg gentamicin IMIV metronidazole 500mg
  9. 9. Endometritis Should be considered in any case of postpartum fever May progress to pelvic abscess, peritonitis,septic shock, or chronic pelvic infection withinfertility Treat with parenteral antibiotics until fever free If fever persists after 72 hours, re-evaluate Consider digital exploration for retained products Consider laparotomy
  10. 10. Abdominal or perineal wounds If pus or fluid, remove sc sutures, drainand debride, damp dressing in wound andreplace every 24 hours If superficial ampicillin and metronidazoleorally If deep and causing muscle necrosis giveAGM IV and REFER
  11. 11. UTICysitis: Ampicillin 500mg orally QDS for 3-5 days or Cotrimoxazole160/800mg orally BD for 3-5 days If infection recurs : Check C&S, give prophylaxisPylonephritis: Ampicillin 2g IV +gentamicin 80mg IM Once afebrile for 48 hrs give amoxycillin for 14/7 Give prophylaxis for remainder of pregnancyand 2 weeks post partum
  12. 12. Breast engorgement and Mastitis If baby not suckling express milk Express milk before suckling to softennipple area Apply compresses and shower beforesuckling Support breasts Analgesia: paracetamol If mastistis develops: Oral ampicillin orerythromycin for 10 days
  13. 13. Breast Abscess Continue feeding-use other breast Support and cold compresses for breast Paracetamol Oral ampicillin or erythromycin for 10/7 REFER for I&D
  14. 14. Malaria Likely cause of fever in pregnant woman inendemic area (but is not sepsis) Can be severe in pregnant women Check for malaria parasites if possible For uncomplicated malaria give first linetreatmentChloroquine 10mg/kg + primaquine0.25mg/kg
  15. 15. TyphoidSuspect if persistent fever, headache,abdominal pain, constipation,diarrhoea, cough, palpable spleen,relative bradycardiaGive ampicillin 1 g by mouth four times for14 days
  16. 16. ?
  17. 17. RECAPRecognition of pregnancy related SepsisCausesPrinciples of Management