Sepsis in pregnancy is an important cause of maternal deaths worldwide with the vast majority of these deaths occurring in low-income countries. In developed countries, septic shock in obstetric patients is relatively rare and not often a reason for ICU admission; eclampsia, preeclampsia and major obstetric haemorrhage are far more common reasons for ICU admission during and after pregnancy.
Due to an altered physiological status in pregnancy, early recognition and treatment of obstetric sepsis can be complicated and different from non-obstetric sepsis. Early recognition and prompt therapy is however, crucial to reduce maternal and foetal morbidity and mortality. The main goal in treating septic shock in pregnancy is to effectively resuscitate the mother as this usually adequately resuscitates the foetus. Early focused empiric antibiotic treatment should be initiated. Sepsis in obstetric patients is primarily the result of pelvic infections such as intra-amniotic infections, endometritis, septic abortions, or urinary tract infections.
We discuss a case of septic shock in an obstetric patient, highlighting the treatment of sepsis in pregnancy with an emphasis on changed physiology. In addition, we will briefly address the consequences of a patient refusing blood products in this context, as our patient did being a practising Jehovah’s Witness.
Back to issue - Download PDF