This document profiles Dr. Laxmi Shrikhande, an obstetrician and gynecologist in India. It lists her extensive qualifications and experience, including various leadership roles in Indian medical organizations. It also outlines her achievements, such as numerous awards and over 450 guest lectures delivered. The document highlights her publications, including 13 national and 11 international publications, as well as her work sensitizing over 200,000 adolescents on health issues.

1.  Chairperson Elect ICOG –Indian College of OB/GY
 National Corresponding Editor-Journal of OB/GY of India JOGI
 National Corresponding Secretary Association of Medical Women, India
 Founder Patron & President –ISOPARB Vidarbha Chapter 2019-21
 Chairperson-IMS Education Committee 2021-23
 President-Association of Medical Women, Nagpur AMWN 2021-24
Dr. Laxmi Shrikhande
MBBS; MD(OB/GY);
FICOG; FICMU; FICMCH
Medical Director-
Shrikhande Fertility Clinic
Nagpur, Maharashtra
 Nagpur Ratan Award @ hands of Union Minister Shri Nitinji Gadkari
 Received Bharat excellence Award for women’s health
 Received Mehroo Dara Hansotia Best Committee Award for her work as
Chairperson HIV/AIDS Committee, FOGSI 2007-2009
 Received appreciation letter from Maharashtra Government for her work in the
field of SAVE THE GIRL CHILD
 Senior Vice President FOGSI 2012
 President Menopause Society, Nagpur 2016-18
 President Nagpur OB/GY Society 2005-06
Delivered 11 orations and 450 guest lectures
Publications-13 National & 11 International
Sensitized 2 lakh boys and girls on adolescent health issues

2. Clinical Features &
Diagnosis of Maternal
Sepsis
Dr Laxmi Shrikhande
Consultant –Shrikhande Hospital
Nagpur

3. Sepsis
 Sepsis is a major health concern.
The reported incidence of sepsis is increasing-
 Aging populations with more comorbidities,
 Greater recognition,and, in some countries,
 Reimbursement-favorable coding
Torio, CM.; Andrews, RM. [Accessed October 31, 2015] National inpatient hospital costs: the most expensive conditions by payer,
2011. Statistical Brief #160. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2013 Aug.
http://www.ncbi.nlm.nih.gov/books/NBK169005/
Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population burden of long-term survivorship after severe sepsis in older Americans. J Am
Geriatr Soc. 2012; 60(6):1070–1077.
Rhee C, Gohil S, Klompas M. Regulatory mandates for sepsis care—reasons for caution. N Engl J Med. 2014; 370(18):1673–1676.

4. Sepsis
 Although the true incidence is unknown, conservative estimates
indicate that sepsis is a leading cause of mortality and critical illness
worldwide.
 Patients who survive sepsis often have long-term physical,
psychological, and cognitive disabilities with significant health care
and social implications
Vincent J-L, Marshall JC, Namendys-Silva SA, et al. ICON Investigators. Assessment of the worldwide burden of critical illness: the Intensive Care Over
Nations (ICON) audit. Lancet Respir Med. 2014; 2(5):380–386
Fleischmann C, Scherag A, Adhikari NK, et al. International Forum of Acute Care Trialists. Assessment of global incidence and mortality of hospital-
treated sepsis: current estimates and limitations. Am J Respir Crit Care Med. 2015
Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;
304(16):1787–1794.

5. Controversies and Limitations-sepsis
 There are inherent challenges in defining sepsis and septic shock.
 First and foremost, sepsis is a broad term applied to an incompletely
understood process.
 There are, as yet, no simple and unambiguous clinical criteria or
biological, imaging, or laboratory features that uniquely identify a
septic patient

6. 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.
Bonet M, Pileggi VN, Rijken MJ, Coomarasamy A, Lissauer D, Souza JP, et al. Towards a Consensus Definition of Maternal
Sepsis: Results of a Systematic Review and Expert Consultation. (unpublished)
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al. The Third International Consensus
Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10

7. Definition of maternal sepsis
Sepsis
Severe Sepsis
Septic Shock
Persistence of hypoperfusion despite
ample fluid replacement
Sepsis + organ dysfunction or
tissue hypoperfusion
(mortality rate 60%)
Sepsis is thought to be the consequence of the body’s inflammatory response to bacterial endotoxins and exotoxins. Cytokines
and immunomodulators are produced by the body to fight infections and in large quantities their release causes a succession of
critical events involving multiple organ systems. When an infection is untreated, this response can cause organ dysfunction,
septic shock and death. (Karsnitz, 2013).
Karsnitz DB. Puerperal Infections of the Genital Tract: A Clinical Review. Journal of Midwifery & Women’s Health. 2013 Nov 1;58(6):632-42. Royal College of Obstetricians
and Gynaecologists. Bacterial sepsis following pregnancy (Green-top Guideline No.64b). Royal College of Obstetricians and Gynaecologists. 2012.
Infection + systemic
manifestations of sepsis
(mortality rate of 20-40%)
RCOG, 2012

8. Incidence -Maternal sepsis
 Maternal sepsis accounts for 11% of maternal deaths world wide and
is the third most common direct cause of maternal death .
 In addition, sepsis contributes to other common causes of maternal
death, such as haemorrhage and thromboembolism.
Say L, Chou D, Gemmill A, et al.: Global causes of maternal death: A WHO systematic analysis. Lancet Glob Health. 2014;
2(6): e323–e333. PubMed Abstract | Publisher Full Text
World Health Organisation: Statement on Maternal Sepsis. (accessed 4 December 2018).

9. Why pregnant women are more
vulnerable to sepsis and its sequelae?
Normal physiological changes in pregnancy
 Hyper dynamic circulation,
 tachycardia,
 diminished oxygen reserve,
 Hypercoagulability
exacerbate the physiological changes brought on during sepsis to
make sepsis life-threatening in pregnancy .
Royal College of Obstetricians and Gynaecologists. Bacterial sepsis in pregnancy (Green-top Guideline No. 64a). Royal College of
Obstetricians and Gynaecologists. 2012.
Van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010
Jun;23(3):249-54.

10. Why are pregnant women more
vulnerable to sepsis and its sequelae?
Postpartum events:
The postpartum period carries heightened risk for sepsis due to the following factors:
 The placental site, a common place for infections to occur, is large, warm, dark
and moist; the perfect conditions for bacteria to thrive.
 The placental site has a rich blood supply that leads directly to the main venous
circulation. This is why septicemia and sepsis can occur quickly.
 Only the vagina (7–10 cm long) separates the entrance to the uterus from the
vulva and perineum, making the uterus vulnerable to exogenous and
endogenous bacteria.
 Tears to the cervix, vagina or perineum during the birth cause traumatized tissue
that is prone to infection. Infection is usually localized initially, but can spread to
underlying and surrounding tissues and into the bloodstream, causing
septicaemia.
World Health Organization. Education Material for Teachers of Midwifery: Midwifery Education Modules- Managing
puerperal sepsis. 2nd ed. Geneva: World Health Organization; 2008.

11. Why is preventing maternal sepsis is a priority?
Maternal perspective:
 To reduce maternal morbidity and mortality.
Neonatal perspective:
 Millennium Development Goal 4.2 aims to reduce the infant mortality
rate and attention must be made to preventing maternal infection for
this rate to decrease.
 Intra-amniotic infections cause neonatal sepsis, pneumonia and
respiratory distress. It is also linked to long-term neurologic
impairment in infants .
Miller AE, Morgan C, Vyankandondera J. Causes of puerperal and neonatal sepsis in resource-constrained settings and
advocacy for an integrated community-based postnatal approach. Int J Gynaecol Obstet. 2013 Oct;123(1):10-5.
Seale AC, Mwaniki M, Newton CRJC, Berkley JA. Maternal and early onset neonatal bacterial sepsis: burden and
strategies for prevention in sub- Saharan Africa. Lancet Infect Dis. 2009 Jul;9(7):428-38.

12. Why is preventing maternal sepsis is a priority?
 The greatest attention has been on PPH and HDP, the two leading
direct causes of maternal mortality .
 However, the third most common direct cause of maternal mortality,
maternal sepsis , received less attention, research and programming.
 Failure to recognise sepsis early is a significant cause of preventable
morbidity, resulting in delayed treatment and escalated care, which
are critical if lives are to be saved .
Chou D, Daelmans B, Jolivet RR, Kinney M, Say L; Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality (EPMM)
working groups. Ending preventable maternal and newborn mortality and stillbirths. BMJ. 2015 Sep 14;351:h4255.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob
Health. 2014 Jun;2(6):e323-33.
United Nations. Sustainable Development Goals. United Nations, New York, 2015. (Available at: https:// sustainabledevelopment.un.org,
accessed 16 December 2016)

13. The challenges of diagnosing maternal sepsis
 The physiological adaptations of pregnancy can make the clinical signs of sepsis
more insidious in pregnant women.
 Pregnancy is associated with a hyperdynamic circulation, and there is a 30 to 50%
increase in circulating volume by 28 weeks of gestation.
 This hyperdynamic circulation can mask cardiovascular signs of sepsis, when,
owing to vasodilation, pregnant women experience a drop in systolic and diastolic
blood pressure, particularly in the first trimester, and a compensatory sinus
tachycardia.
 Tachypnoea caused by sepsis can be confused with the physiological tachypnoea
in pregnancy caused inter alia by elevated progesterone levels.
Rebelo F, Farias DR, Mendes RH, et al.: Blood Pressure Variation Throughout Pregnancy According to Early Gestational BMI: A Brazilian
Cohort. Arq Bras Cardiol. 2015; 104(4): 284–91.
Bauer ME, Bauer ST, Rajala B, et al.: Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a
systematic review and meta-analysis. Obstet Gynecol. 2014; 124(3): 535–41.

14. The challenges of diagnosing maternal sepsis
 In the UK, the RCOG recommends the use of the Modified Early
Obstetric Warning System (MEOWS) to detect signs of sepsis and to
trigger escalation to senior review of patients with features of
concern, as it has been demonstrated to have an 89% sensitivity and
79% specificity in identifying maternal morbidity when validated
amongst 676 patients in a UK hospital.
Singh S, McGlennan A, England A, et al.: A validation study of the CEMACH recommended modified early obstetric warning system
(MEOWS). Anaesthesia. 2012; 67(1): 12–8

15. MEOWS: Maternal Early Obstetrical Warning Score
Valid & Accurate & Applicable For Maternal Illness
Assessment
- High rate of detection (sensitive; true positive)
- High negative predictive rate (specific; true negative)
- Low rate of false positive (alert fatigue)
- Tailored to the clinic setting, patient population
2 yellow or 1 red alert triggers MD
evaluation

16. The challenges of diagnosing maternal sepsis
Many other obstetric early-warning systems, such as the Maternal Early
Warning Score (MEWS) and the Maternal Early Warning Trigger Tool
(MEWT), are available.
These tools, particularly the MEWT tool, which is aimed at early
identification and treatment of the four commonest causes of maternal
morbidity (sepsis, haemorrhage, cardiopulmonary dysfunction, and
hypertension), have shown promise.
When first introduced, this reduced severe maternal morbidity by 18%.
 However, the positive predictive value (PPV) of these tools for sepsis is
low.
Shields LE, Wiesner S, Klein C, et al.: Use of Maternal Early Warning Trigger tool reduces maternal morbidity.
Am J Obstet Gynecol. 2016; 214(4): 527.e1–527.e6

17. Screening and diagnosis of maternal sepsis
 Bauer et el.came out with screening tools for sepsis in pregnant women in
2019..
 The sensitivity and specificity of sepsis screening tools with the highest to
lowest sensitivity were systemic inflammatory response syndrome,
maternal early warning, and quick sequential organ failure assessment
(qSOFA) criteria, and the highest to lowest specificity were qSOFA,
maternal early warning, and systemic inflammatory response syndrome.
 Foeller and Gibbs proposed an obstetrically modified qSOFA.
 Currently, there are no ideal screening tools for sepsis in pregnancy
Bauer ME, Housey M, Bauer ST, et al. Risk factors, etiologies, and screening tools for sepsis in pregnant
women: a multicenter casecontrol study. Anesth Analg 2019;129(6):1613–1620.

18. Risk factors for maternal sepsis
Maternal risk factors
Birthing condition risk
factors
•Cesarean section
•Multiple vaginal exams (>5)
•Unhygienic conditions
•Prolonged rupture of
membranes
•Prolonged labor
•Multiple obstetrical maneuvers
•Retained products of
conception
• Anemia
• Poor nutrition
• Existing infection
(HIV/AIDS, Malaria)
• Primiparity
• Multiple pregnancy
• Obesity
Community risk
factors
• Low socioeconomic
status
• Lack of adequate
healthcare
• Untrained birth attendant
Infection
Van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis.
2010 Jun;23(3):249-54.
The Global Library of Women’sMedicine. The Safer Motherhood Knowledge Transfer Program: Maternal Sepsis- Prevention
Recognition Treatment. The Global Library of Women’sMedicine. Unknown date.

19. Obstetric sepsis- High index of suspicion
 Older
 Socially disadvantaged
 Unplanned obstetric event
 Late intra uterine death
 Obese
 Diabetic
 Illness in family‐ esp. apparent URTI in children
 Undifferentiated presentation

20. Common causes of maternal sepsis
Maternal
Sepsis
Genital tract infections
(eg.endometritis,
chorioamnionitis)
Puerperal
Sepsis
Severe Sepsis
Mastitis
Incidental
infections
(eg. Respiratory
Infections)
Others: related to
labor and birth
(eg.UTIs/urinary
tract)
Untreated / treated infections
Septic Shock
Bamfo JEAK. Managing the risks of sepsis in pregnancy. Best Pract Res Clin Obstet Gynaecol.
2013 Aug;27(4):583-95.

21. Specific clinical syndromes associated with maternal sepsis
 Chorioamnionitis In Labor.
 PPROM –Preterm Prelabour rupture of membranes at <37 weeks.
 PROM- Prelabour rupture of membranes.
 Acute Pyelonephritis with pregnancy.
 Endometritis
 Mastitis and Breast Abscess
 Puerperal Wound Infection

22. Clinical syndromes: Chorioamnionitis in labor
 Definition: Inflammation of the amnion and/or chorion from ascending pathogens; usually affects
the amniotic fluid, fetal membranes, placenta and/or uterus (Fahey 2008).
 Newborn complications of chorioamnionitis include: neonatal sepsis and pneumonia (Czikk 2011)
with Neonatal mortality 1-4% for term infants and 10% for preterm infants (Fahey 2008).
 Perinatal complications: Chorioamnionitis presents a significant risk for PPROM, preterm birth,and
 cesarean section (Fahey 2008)
 Maternal complications: 5-10% of women with chorioamnionitis will develop bacteremia (Fahey,
2008)
 Chorioamnionitis increases maternal risk for postpartum hemorrhage, wound infections, pelvic
abscesses and postpartum endometritis (Fahey 2008).
Diagnosis: commonly based on clinical symptoms:
 maternal fever (>38°C),
 maternal tachycardia (≥100-120 bpm),
 fetal tachycardia (≥160 bpm),
 uterine tenderness,
 purulent amniotic fluid and
 maternal leukocytosis (>15,000-18,000 cells/mm3).
However, treating based on these symptoms alone often leads to over-diagnosis (Fahey 2008).
Czikk MJ, McCarthy FP, Murphy KE. Chorioamnionitis: from pathogenesis to treatment. Clin Microbiol Infect. 2011Sep;17(9):1304-11.
Fahey JO. Clinical management of intra-amniotic infection and chorioamnionitis: a review of the literature. J Midwifery Womens Health. 2008 Jun;53(3):227- 35.

23. Clinical syndromes: PPROM – at <37 weeks
PPROM occurs in approximately 2% of pregnancies but is associated with 40% of preterm births. There
is an association between ascending infection from the lower genital tract and PPROM which may lead
to preterm births and its sequelae.
Diagnosis is best based on
 maternal history and a
 sterile speculum examination.Amniotic fluid pooling in the vagina is visible on speculum exams.
 Ultrasound examinations (demonstrating oligohydraminos) may be used to confirm the diagnosis.
Royal College of Obstetricians and Gynaecologists. Preterm Prelabour Rupture of Membranes (Green-top Guideline
No. 44). Royal College of Obstetricians and Gynaecologists. 2006, amended 2010.
Do’s Don’ts
• Observe the woman for signs and
symptoms of chorioamnionitis,
• Perform a cardiotogography to
diagnose fetal tachycardia
• Treat group Beta Streptococcus if it is
isolated in cases of PPROM
• Give antenatal corticosteroids to
women between 24-34 weeks gestation
• Consider delivery from 34 weeks of
gestation.
• Give Erythromycin for 10 days following
diagnosis of PPROM.
• Perform unnecessary digital
examinations.
• Perform weekly high vaginal swabs,
CBC, or C-reactive protein.
• Carry out Amniocentesis fordiagnosis
of uterine infection
• Give Tocolytic agents
• Prescribe Co-amoxiclav as it increases
the risk of neonatal necrotizing
enterocolitis.

24. Clinical syndromes: Postpartum maternal sepsis
Postpartum infections account for 46-47% of maternal sepsis and most arise from:
 Endometritis
 Mastitis
 Perineal and abdominal wounds
 Urinary tract infections
Long-term morbidity may include:
 chronic pelvic inflammatory disease
 chronic pelvic pain
 bilateral tubal occlusion
 infertility
Bamfo JEAK. Managing the risks of sepsis in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013 Aug;27(4):583-95.

25. Clinical syndromes: Puerperal wound infection
In resource-poor countries wound infection rates following childbirth can be as high as 20%.
These infections usually begin at the site of an episiotomy, perineal laceration or caesarean section.
Risk Factors include:
 prolonged rupture of membranes
 compromised skin integrity
 poor suturing or incision repair techniques
 insufficiently achieving hemostasis during repairs
Signs and symptoms:
 pain or discomfort at a perineal or abdominal wound site
 purulent wound discharge
 wound dehiscence or inflamed wound edges
 edematous perineum
 hip pain
 low-grade fever
Karsnitz DB. Puerperal infections of the genital tract: a clinical review. J Midwifery Womens Health. 2013 Dec;58(6):632-42.

26. Clinical syndromes: Puerperal wound infection
Management of perineal wound infections includes-
 removal of sutures with wound debridement and cleansing
 sitz baths
 broad-spectrum antibiotics.
 Secondary wound repair is necessary in third or fourth degree lacerations.
Abdominal wounds may need to be debrided and reclosure performed in the case of wound
dehiscence.
Complications include abscess, wound extension, septic pelvic thrombophlebitis and
necrotizing fasciitis.
Karsnitz DB. Puerperal infections of the genital tract: a clinical review. J Midwifery Womens Health. 2013 Dec;58(6):632-42.

27. Clinical syndromes: Endometritis
Etiology Risk Factors Symptoms and
signs
Management Complications
Inflammation of
the uterine lining
Symptoms
present in first5
days
Note: women who
would like an
intrauterine device
placed must be
infection-free for 3
months prior to
insertion
• Cesarean birth
• Prolonged rupture
of membranes
• Increased vaginal
exams
• Retained placental
parts
• Postpartum
hemorrhage
• Group B
streptococcus
colonization
• Chorioamnionitis
• Fever
• Uterine
tenderness
• Purulent lochia
• Subinvolution
• Pelvic pain
• Malaise
• History and
physical exam
• CBC with
differential
• BMP
• Urine culture
• Blood culture
• Cervical and
endometrial
cultures should
be done if GAS
is suspected
• Notify pediatric
provider if GAS
cultures are
positive
• Antibiotics
• Abscess
• Hematoma
• Necrotizing
fasciitis
• Septic pelvic
thrombophlebitis
• Pelvic infections
Karsnitz DB. Puerperal infections of the genital tract: a clinical review. J Midwifery Womens Health. 2013 Dec;58(6):632-42.

28. Clinical syndromes: Mastitis
Most cases of mastitis occur in the first 6 weeks postpartum but it can occur at anytime during lactation. It affects anywhere from 3-
20% of lactating women.
Definition: Mastitis is the inflammation of the breast that may or may not involve a bacterial infection.
There may be a spectrum of mastitis from engorgement to non-infective mastitis to infective mastitis to abscess.The most common
pathogen for infective mastitis is S. aureus.
Risk Factors include: (most risk factors are related to milk stasis)
•Damaged nipples (especially if colonized with Staphylococcusaureus)
 Infrequent feedings
 Missed feedings
 Poor attachment of the baby to the nipple leading to inefficient milkremoval
 Illness in mother or baby
 Oversupply of milk
 Rapid weaning
 Tight pressure on the breast from tight bras or seatbelts
 Maternal stress and fatigue
 White spot on the nipple or blockedduct
Diagnosis-Signs and symptoms include:
 a tender, hot, swollen, wedge-shaped area on the breast
 Fever of 38.5°C or greater
 Flu-like aches
 Systemic illness
Amir LH. The Academy of Breastfeeding Medicine Protocol Committee. Breastfeeding Medicine. 2014 Jun 1;9(5):239-43.

29. Clinical syndromes: Breast abscess
Breast abscess: a well-defined portion of the breast that remains hard,
red and tender despite appropriate interventions.
It occurs in about 3% of women with mastitis.
 Breast ultrasound to identify collection of fluid
 Needle aspiration to drain fluid—send for culture
 Continue breast feeding
 Administer antibiotics
Amir LH. The Academy of Breastfeeding Medicine Protocol Committee. Breastfeeding Medicine. 2014 Jun 1;9(5):239-43.

30. Diagnosis of sepsis: (International surviving sepsis campaign)
Item Diagnostic feature
Clinical Localizing
features
• Fever or rigors
• Diarrhea or vomiting (may be sign of early TOXICshock)
• Abdominal/pelvic pain and tenderness.
• Offensive vaginal discharge (strong odor suggests anaerobes;
serosanguinous suggests streptoccocal infection)
• Subinvolution of the uterus in postpartumperiod.
• Productive cough
• Urinary symptoms
General features • Fever (>38°C) or Hypothermia (core temp <36°C)
• Tachycardia (>90 beats/minute)
• Tachypnoea (>20 breaths/minute)
• Impaired mental state, altered consciouslevel
• Considerable edema or positive fluid balance (> 20ml/kg over 24hours)
• Hyperglycaemia in the absence of diabetes (plasma glucose>7.7mmol/l)
Adapted from:
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, et el. Surviving Sepsis Campaign: International guidelines for
management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008 Jan;34(1):17- 60.
Royal College of Obstetricians and Gynaecologists. Bacterial sepsis in pregnancy (Green-top Guideline No. 64a).
Note that these features are for diagnosis of sepsis in general and not specific to maternal sepsis

31. Differential diagnoses of maternal sepsis
The differential diagnoses include
 hypovolemic or haemorrhagic shock,
 pulmonary embolism,
 myocardial infarction,
 acute pancreatitis,
 diabetic ketoacidosis,
 primary adrenal insufficiency, and
 transfusion reaction.
Burlinson CEG, Sirounis D, Walley KR, et al. Sepsis in pregnancy and the puerperium. Int J Obstet Anesth 2018;36:96–107.

32. General management of maternal sepsis - Management
of suspected genital tract sepsis
Sinha P, Otify M. Genital tract sepsis: early diagnosis, management and prevention. The Obstetrician & Gynaecologist. 2012 Apr
1;14(2):106-14.

33. Key interventions for prevention of maternal sepsis
Early recognition, diagnosis and prompt treatment decreases complications and the risk of
sepsis that can arise from genital tract infections .
The following priority interventions are recommended:
 Treat PPROM (RCOG 2010)
 Maintain asepsis during birth (Karsnitz 2013)
 Perform rigorous hand washing during birth (Karsnitz 2013)
 Make minimal use of invasive procedures (Karsnitz 2013)
 Teach all pregnant and recently postpartum women signs and symptoms of genital tract
infections (RCOG 2012).
 Be vigilant for endometritis during the postpartum period (Karsnitz2013)
 Ensure an early home visit or postnatal care facility for woman and baby (Karsnitz2013)
Karsnitz DB. Puerperal infections of the genital tract: a clinical review. J Midwifery Womens Health. 2013 Dec;58(6):632-42.
Royal College of Obstetricians and Gynaecologists. Preterm Prelabour Rupture of Membranes (Green-top Guideline No. 44).
Royal College of Obstetricians and Gynaecologists. Bacterial sepsis in pregnancy (Green-top Guideline No. 64a). Royal College of
Obstetricians and Gynaecologists. 2012.

34. Summary and Recommendations-Maternal
Sepsis
 Sepsis remains a major cause for the admission of pregnant women to the
intensive care unit and is a leading cause of maternal morbidity and
mortality.
 The causes of maternal sepsis include obstetric and non-obstetric causes.
 Maternal sepsis may also be from obstetrical critical illness.
 The most commonly reported pathogens in maternal sepsis include E. coli,
Streptococcus, Staphylococcus, and other gram-negative bacteria.
 The management of sepsis during pregnancy should follow the same basic
principles as that in the nonpregnant population, including early
recognition, fluid therapy, timely broad-spectrum antibiotics, and source
control

35. My World of sharing happiness!
Shrikhande Fertility Clinic
Ph- 91 8805577600
shrikhandedrlaxmi@gmail.com

36. Questions

37. The Art of Living
Anything that helps
you to become
unconditionally happy
and loving is what is
called spirituality.
H. H. Sri Sri Ravishakar