As labour is different but risks remain note small changes in highlighted parameters that should be considered but err on overdiagnosis / response if in doubt.
Sepsis: Clinical symptoms of infection (fever, sweats, chills or rigors, malaise, etc.) as per local MEWS and triggers or proven infection and at least two of the following:
- Temperature <36°C or >38°C
In labour a temperature of ≥ 37.5°C on 2 separate occasions at least 2 hours apart
- Tachycardia HR > 100 bpm or
>110bpm in labour
- Tachypnoea RR > 20 breaths/minute or
>22 breaths/minute in labour
- WCC < 4 or > 16 x 109/L
WCC in labour > 20 x 109/L (although WCC up to 30 have been observed in labour, a WCC of 20 is the generally recommended threshold for investigation in the literature)
Serious or severe sepsis: sepsis with any of the following:
- Organ dysfunction/ hypoperfusion (lactic acidosis, oliguria, or confusion) – pregnancy results in a relative respiratory alkalosis
- Hypotension (systolic BP < 90 mmHg or MAP < 65 or a systolic reduction of more than 40 mmHg from baseline)
N.B. Signs of sepsis may be masked in immunosuppression and in the presence of anti-inflammatory drugs or beta blockers. CRP does not reflect the severity of infection and may remain elevated even when infection is resolving; it cannot be used in isolation to assess the severity of infection and hence the need for IV therapy.
Mortality from sepsis and severe sepsis increases with each hour of delay in initiating IV antibiotic therapy. In patients with sepsis, aim to complete the “Sepsis 6” within 1 hour:
- Oxygen therapy (target saturation 94 – 98% or 88 – 92% for those with chronic obstructive pulmonary disease).
- Blood cultures and relevant swabs
- Take Lactate, FBC, CRP U+E, Coag, G+S, +/-ABG
- Antibiotics Intravenous (as per local guidelines)
- IV fluids challenge
- Note urine output fluid balance (consider catheterisation in some patients)
Record first dose of antibiotic in the ‘one-off’ section of the kardex and communicate with the member of staff who is responsible for administration of IV antibiotic therapy to ensure it is administered immediately. Administer the antibiotic in the clinical area where infection has been recognised and do not delay until arrival at the destination ward.