Updates in Management of Maternal Sepsis

Abstract

Severe sepsis and septic shock represent one of the oldest and most pressing problems in medicine. With advances in intensive care, increased awareness, and dissemination of evidence-based guidelines, clinicians have taken large strides in reducing the risk of imminent death associated with sepsis. However, as more patients survive sepsis, concern mounts over the lingering sequelae of what was previously a lethal event. Severe sepsis and septic shock compromise tissue perfusion, which untreated leads to tissue hypoxia, cell death, and end-organ failure. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. This can be achieved by formulating a stepwise approach that consists of early provision of time-sensitive interventions such as aggressive hydration, initiation of appropriate broad-spectrum antibiotics, central hemodynamic monitoring, and the involvement of pharmacy, infectious disease specialists, and critical care specialists familiar with the physiologic changes in pregnancy. The adoption of hospital-wide, guideline-based performance improvement programs targeting severe sepsis has demonstrated mortality benefit. Furthermore, this benefit was observed to increase with level and duration of compliance.