EMed

Septicaemia in Obstetrics

Background

  • After caesarean section, termination of pregnancy
  • 6% of maternal mortality
  • E. Coli, ß-haemolytic strep, bacteroides, clostridia

Clinical

  • Confused, restless, coma
  • Warm sweaty extremities becoming cold
  • Peripheral or central cyanosis
  • Tachypnoea, tachycardia, hypotension
  • Jaundice, DIC

Treatment

  • O2, intubation/ventilation
  • CVP, Swan-fluid replacement, FFP
  • Antibiotics - after cultures
  • Augmentin, Metronidazole, Gentamicin

Toxic shock syndrome

Please see main TSS page

  • > 38.5°, initially mild erythema (especially palms), later multiorgan failure
  • Staph toxin (TSST-1) ("TSS like syndrome" very similar but = group A strep)
  • Postural hypotension
  • Involve Microbiology and ITU early in all suspected cases
  • Send cultures, U&E, LFT, Coag, CK
  • Cultures may be negative - perform gram stain
  • Beware early signs organ dysfunction ± ARDS
  • May need massive fluid resuscitation ± ITU
  • Remove appropriate material
  • Flucloxacillin

Content by Dr Íomhar O' Sullivan 29/12/2002. Reviewed by Dr ÍOS 01/05/2005, 19/01/2007, 15/06/21.