Recognise Sepsis
The maternal sepsis pathway covers pregnancy and how many weeks after pregnancy?
Up to six weeks after pregnancy.
How many red flags are needed to start Sepsis Six +2 immediately?
One or more.
Within what timeframe should Sepsis Six +2 be completed?
Within one hour. Do not delay for investigations or results.
Which blood test helps identify hypoperfusion and is included in sepsis screening?
Lactate.
Name two risk factors for maternal sepsis listed in the pathway.
previous sepsis, chronic medical conditions, immunosuppression, prolonged rupture of membranes, recent trauma, surgery/procedure or hospital admission, socioeconomic deprivation, Māori or Pacific ethnicity.
Is persistent whānau concern a red flag or an amber flag?
An amber flag. Whānau concern is part of the clinical assessment and must be taken seriously.
How many sets of blood cultures are required, and should they still be taken if the person is afebrile?
At least two sets from a single site. Yes—even if afebrile. Ensure bottles are properly filled.
How often should urine output be documented?
Hourly.
A pregnant person has suspected infection, a temperature of 38.2°C and a fetal heart rate of 170 bpm. Should you continue sepsis screening, and why?
Yes. With suspected infection, a temperature ≥38°C or fetal tachycardia >160 bpm meets criteria to continue screening for red and amber flags.
A postnatal person with suspected infection has a heart rate of 135 bpm and systolic blood pressure of 88 mmHg. Identify the flags and the required action.
Two red flags: HR ≥130 and systolic BP ≤90. Start Sepsis Six +2 immediately.
Name the six actions in “Sepsis Six”
Give oxygen if indicated; draw blood cultures; obtain lactate and a full set of bloods; give IV fluids if indicated; give IV antibiotics; get senior clinical help.
Name three blood investigations required alongside lactate and blood cultures.
full blood count, urea and electrolytes, CRP, liver function tests, coagulation studies.
A person with suspected infection immediately after birth has a lactate of 2.3 mmol/L. A student says, “Labour can raise lactate, so we can ignore it.” How would you respond?
Lactate can rise during and immediately after normal labour and birth, but it must not be dismissed. Lactate ≥2 mmol/L is a red flag in this pathway. Assess the full clinical picture and start Sepsis Six +2 according to the pathway.
A postnatal person with suspected infection has a heart rate of 115 bpm, systolic BP of 96 mmHg and persistent whānau concern. Identify the flags and the next step
Three amber flags: HR 100–129, systolic BP 91–100, and persistent whānau concern. With two or more amber flags, send bloods including lactate and two sets of blood cultures, then review the results for a new red flag or acute kidney injury.
A person with red flag sepsis has an oxygen saturation of 91% and systolic BP of 86 mmHg. What immediate oxygen and fluid actions does the pathway specify?
Give oxygen, targeting saturation ≥94%. Give 500 mL IV fluid stat for hypotension, repeating if clinically indicated up to 30 mL/kg ideal body weight. Continue the remaining Sepsis Six +2 actions and obtain senior help.
A person with suspected infection has two amber flags and no red flags. What investigations are required, and what findings would trigger Sepsis Six +2?
Send bloods, including lactate, and two sets of blood cultures. Review the results. A new red flag or acute kidney injury triggers Sepsis Six +2.