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Severe sepsis with acute organ dysfunction has a mortality rate of up to 40%, which increases to 60% if septic shock develops.[2] The early recognition of sepsis and implementation of evidence-based therapies have been documented to improve outcomes and decrease sepsis-related mortality [3]

The Sepsis in Obstetrics Score (S.O.S.) was created by modifying validated scoring systems in accordance with recognized physiologic changes of pregnancy. Albright CM, et. al., found an S.O.S. >= 6  to be independently associated with increased ICU or telemetry unit admissions, positive blood cultures, and fetal tachycardia [1]. Prospective validation is warranted.


Sepsis Obstetrics Scoring System

Temperature (Centigrade) (o C) *    

SpO2%  blood oxygen saturation

Systolic blood pressure (mmHg)    

White blood count uL   

Heart Rate (beats per minute)     

% Immature Neutrophils   

Respiratory Rate (breaths per minute )

Lactic Acid (mmol/L)


* One study found only 18% of women who died of sepsis were febrile on presentation and 25% never developed a fever at all [6].

The positive predictive value of an early warning system would be expected to be improved when applied to a population with a high prevalence of the condition being screened for.
 
Risk factors for the development of or progression to severe sepsis in pregnancy [2, 3,4]

Women who have had a febrile illness or have been taking antibiotics 2 weeks prior to presentation Prolonged spontaneous rupture of membranes
Chronic hypertension, preeeclamspia postpartum hemorrhage Obesity
Impaired glucose tolerance / diabetes Anemia
Impaired immunity/ immunosuppressant
   medication
Vaginal discharge
Cesarean section History of pelvic infection
Operative vaginal delivery History of group B streptococcal infection
Multiple birth Amniocentesis and other invasive procedures
Being primiparous Cervical cerclage
Being black or from an other minority ethnic
   group
Group A streptococcus (GAS) infection in close contacts / family members

The two most common organisms identified in women dying of peripartum sepsis have been
reported to be E coli. and  group A streptococcus (GAS) [2,5,6]

In cases of suspected bacterial sepsis, when the source of infection is unclear , the Royal College of Obstetricians and Gynaecologists recommends ,empirically, broad spectrum antimicrobials active against Gram-negative bacteria, and capable of preventing exotoxin production (e.g. clindamycin) * from Gram-positive bacteria such as GAS , should be used , and therapy narrowed once the causative organism(s) has been identified [2]

REFERENCE:

1.Albright CM, et. al., The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. 2014 Jul;211(1):39.e1-8. doi: 10.1016/j.ajog.2014.03.010. Epub 2014 Mar 12. PMID: 24613756
2. Bacterial Sepsis in Pregnancy RCOG Green-top Guideline No. 64a. Royal College of Obstetricians and Gynaecologists, 2012 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_64a.pdf
3. Levy MM, Dellinger RP, Townsend SR, et al; Surviving Sepsis Campaign: The Surviving Sepsis Campaign: Results of an internationalguideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010; 38:367374
4. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al.. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580637.
http://www.sccm.org/Documents/SSC-Guidelines.pdf

5. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012 Sep;120(3):689-706. doi: 10.1097/AOG.0b013e318263a52d. Review. Erratum in: Obstet Gynecol. 2012 Nov;120(5):1214. PMID:22914482
6. Bauer ME, et. al., Maternal Deaths Due to Sepsis in the State of Michigan, 1999-2006. Obstet Gynecol. 2015 Oct;126(4):747-52. PMID: 26348189


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