Maternal Sepsis during Pregnancy and Puerperium: SMFM releases new recommendations
The Society for Maternal-Fetal Medicine (SMFM) has released new recommendations related to the diagnosis and treatment of sepsis which aims at reducing maternal morbidity and mortality. The "SMFM Consult Series 47: Sepsis During Pregnancy and the Puerperium," is endorsed by the American College of Obstetricians and Gynecologists and published in the American Journal of Obstetrics and Gynecology.
Sepsis is not a specific illness; rather it is a syndrome characterized by life-threatening organ dysfunction. Sepsis in pregnancy is associated with an increased risk of preterm birth, prolonged recovery, stillbirth and maternal death. In 63% of maternal sepsis deaths, independent reviewers found substandard care, most often a delay in recognition or management of sepsis, and most often on the obstetric unit of the hospital.
The Key Recommendations are :
- We recommend that sepsis and septic shock be considered medical emergencies and that treatment and resuscitation begin immediately (GRADE1B);
- We recommend that providers consider the diagnosis of sepsis in pregnant patients with otherwise unexplained end-organ damage in the presence of an infectious process, regardless of the presence of fever (GRADE 1B);
- We recommend that empiric broad-spectrum antibiotics be administered as soon as possible, ideally within 1 hour, in any pregnant woman in whom sepsis is suspected (GRADE 1B);
- We recommend obtaining cultures (blood, urine, respiratory, and others as indicated) and serum lactate levels in pregnant or postpartum women in whom sepsis is suspected or identified, and early source control should be completed as soon as possible (GRADE 1C);
- We recommend early administration of 1e2 L of crystalloid solutions in sepsis complicated by hypotension or suspected organ hypoperfusion (GRADE 1C);
- We recommend the use of norepinephrine as the first-line vasopressor during pregnancy and the postpartum period in sepsis with persistent hypotension and/or hypoperfusion despite fluid resuscitation (GRADE 1C);
- We recommend against immediate delivery for the sole indication of sepsis and that delivery should be dictated by obstetric indications (GRADE 1B).
The new "SMFM Consult Series" and accompanying resources detail seven specific recommendations for obstetric care providers. "The treatment of sepsis during pregnancy should follow the same basic principles in the nonpregnant population," said Judette Louis, MD, an author of the publication and the president-elect of SMFM. "Our goal is to improve care and prevent future sepsis deaths or organ damage caused by sepsis."
There are certain risk factors that increase the likelihood of maternal sepsis, including nulliparity, black race, public or no insurance, cesarean delivery, assisted reproductive technologies and multiple gestations. "The rate of sepsis appears to be increasing," said Dr. Louis. "Therefore, it is increasingly important to identify sepsis early and save women's lives.
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