Sepsis during pregnancy

Abstract

Objectives: To provide a current review of the literature regarding the assessment and management of sepsis during pregnancy. Design: A comprehensive review of current English-language literature search was performed with Ovid MEDLINE using the Medical Subject Headings pregnancy and sepsis, with Medical Subject Headings or keywords seeking randomised controlled trials and clinical reports, and by reviewing the bibliographies of clinical practice guidelines. Results: Sepsis-related maternal morbidity and mortality is a significant and persistent problem in the modern critical care obstetric unit. The management of sepsis during pregnancy is challenging. The obstetric intensivist must simultaneously discern the effect of maternal physiologic changes on fetal vulnerability and the effect of the fetus on maternal status throughout the various phases of pregnancy. Little direct evidence exists to validate the extrapolation of some sepsis treatment modalities from other nonpregnant patient populations. Nevertheless, early defection, accurate diagnosis, and aggressive appropriate treatment strategies may significantly improve outcome. Approaches like tine Surviving Sepsis Campaign guidelines are unproven but seem reasonable and practical. Conclusions: Sepsis during pregnancy is uncommon yet potentially fatal. Diagnostic and therapeutic guidelines should predominantly pattern those currently utilized for nonpregnant patients. Copyright © 2005 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.