1. SEPSIS

2. Aims
 To recognise sepsis
 To practise an effective response to a
woman with sepsis
 To achieve competence in those skills

3. Sepsis
 Major cause of maternal mortality
In labour and Delivery:
 Suspect if fever, preterm labour, foul
smelling watery discharge
After delivery:
 Suspect if fever +/- offensive lochia and
boggy uterus

4. Causes of fever during
pregnancy and after delivery
 Septic abortion
 Chorioamnionitis
 UTI (pyelonephritis)
 Chest infection
 Phlebitis
 Hepatitis

5. Causes of fever during
pregnancy and after delivery
 Puerperal sepsis (Endometritis, pelvic
abscess, peritonitis)
 Wound infections
 Mastitis, breast abscess
 Meningitis
 Malaria, enteric fever

6. Recognition of Sepsis
 Fever: temperature > 38 oC
 Warm extremities
 Fast breathing
 Increased maternal and fetal heart rate
 Altered mental state
 Low BP
 Septic shock

7. General Management Principles
 ABCs
 If conscious, increase oral fluid intake and
in all start iv fluids
 Treat fever
 Start iv antibiotics
 Treat underlying causes
 Prompt REFERAL

8. General Management Principles
• Antibiotic therapy (AGM)
Not Severe: oral ampicillin 1g, 80mg gentamicin
IM, oral metronidazole 400mg
Severe: IV ampicillin 1g stat, 80mg gentamicin IM
IV metronidazole 500mg

9. Endometritis
 Should be considered in any case of post
partum fever
 May progress to pelvic abscess, peritonitis,
septic shock, or chronic pelvic infection with
infertility
 Treat with parenteral antibiotics until fever free
 If fever persists after 72 hours, re-evaluate
 Consider digital exploration for retained products
 Consider laparotomy

10. Abdominal or perineal wounds
 If pus or fluid, remove sc sutures, drain
and debride, damp dressing in wound and
replace every 24 hours
 If superficial ampicillin and metronidazole
orally
 If deep and causing muscle necrosis give
AGM IV and REFER

11. UTI
Cysitis:
 Ampicillin 500mg orally QDS for 3-5 days or
 Cotrimoxazole160/800mg orally BD for 3-5 days
 If infection recurs : Check C&S, give prophylaxis
Pylonephritis:
 Ampicillin 2g IV +gentamicin 80mg IM
 Once afebrile for 48 hrs give amoxycillin for 14/7
 Give prophylaxis for remainder of pregnancy
and 2 weeks post partum

12. Breast engorgement and Mastitis
 If baby not suckling express milk
 Express milk before suckling to soften
nipple area
 Apply compresses and shower before
suckling
 Support breasts
 Analgesia: paracetamol
 If mastistis develops: Oral ampicillin or
erythromycin for 10 days

13. Breast Abscess
 Continue feeding-use other breast
 Support and cold compresses for breast
 Paracetamol
 Oral ampicillin or erythromycin for 10/7
 REFER for I&D

14. Malaria
 Likely cause of fever in pregnant woman in
endemic area (but is not sepsis)
 Can be severe in pregnant women
 Check for malaria parasites if possible
 For uncomplicated malaria give first line
treatment
Chloroquine 10mg/kg + primaquine
0.25mg/kg

15. Typhoid
Suspect if persistent fever, headache,
abdominal pain, constipation,
diarrhoea, cough, palpable spleen,
relative bradycardia
Give ampicillin 1 g by mouth four times for
14 days

16. ?

17. RECAP
Recognition of pregnancy related Sepsis
Causes
Principles of Management