Obstetric sepsis

• Devyatova E.A.

Abstract

Objective. Sepsis is a major cause of maternal mortality (MM) and complicated pregnancy and it rates 15 % of MM worldwide. Septic shock during pregnancy is 2,3 cases per 100 000 deliveries. Possibly, this indicator is not sharp by the reason of lack in registered obstetric cases and differences in classifications. Sepsis problem understanding and control are connected with absence of common classification, variety of reasons and risk factors, vital characteristics peculiarities in pregnancy, proper diagnostic difficulties, missed start-therapy time, deficient data in pregnant population about various factors of septic disorders.

Aims. Establishment of: 1) common infects and reasons of sepsis in pregnancy; 2) significant risk factors for maternal sepsis; 3) effective approaches in detection and management of high-risk pregnancy in septic disorders development; 4) reserves for increasing of medical care quality in pregnancy complicated with septic disorders.

Materials and methods. Limited to the English literature PubMed, EMBASE, MedLine and the Cochrane Library were searched for randomised trials in 2013–2014, devoted to maternal sepsis problems: classification, ethyology, risk management, medical approach, care strategies.

Results. Reasons of sepsis in pregnancy include pregnancy-associated infections and system infections. Risks are divided on obstetric and non-obstetric factors. Due to increasing rates of complicated septic pregnancies and MM, quick-targeted detection of these cases becomes essential, as early-started therapy provides positive prognosis. The Sepsis in Obstetrics Score (SOS) can be helpful for intensive care unit in choosing potentially septic pregnancies to form the approach and provide high level of medical care in these cases. But SOS requires further research. In cases suspicious for maternal sepsis «Algorithms of intensive care for sepsis» or similar protocols should be applied. Nowadays there is necessity in working out of modern protocols and training programs for medical stuff in diagnostics and early-time targeted intensive therapy of maternal sepsis, based on haemodynamic parameters, proper antibiotic therapy usage, forehanded septic whence elimination.

Keywords:sepsis, maternal mortality, intensive care unit, septic shock, risk management

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