Recognise
When do you use the Maternal Sepsis Pathway
For all pregnant women and up to six weeks post-pregnancy, including any perinatal loss,
When do you call a rapid respond (in regard to sepsis)?
ANY RED ZONE observation OR additional criteria (including lactate ≥ 4 mmol/L)
or
When there has been no response after 30 minutes for a Teir 1
The New Maternal Sepsis Pathway has little visual clock reminders.
What does it suggest you do in the first 5 minutes?
Escalate as per local CERS (if not already called)
Consult with Obstetrician / senior clinician
Give oxygen as required to maintain SpO2 ≥ 95%
Commence monitoring
What should your initial bolus IV fluids be?
Who should sign the Maternal Sepsis Pathway?
Medical Officer - person initiating
What are three signs of sepsis?
Myalgia, back pain, general malaise, headache Unexplained abdominal pain, distension Vomiting, diarrhoea
New confusion, change in behaviour or altered level of consciousnes
History of fevers, rigors or feeling cold Flu-like symptoms, cough, sputum, breathless
Breast, wound or line redness, swelling, pain (including epidural block site)
Dysuria, oliguria, frequency, odour
Is temperature instability consistent with sepsis?
Yes - Temperature instability is consistent with sepsis
What are the pathology tests you should be collecting in the first 30 minutes?
Lactate (unless collected)
Pathology (FBC, EUC, LFTs, fibrinogen, coagulation screen, VBG + CRP if available)
Blood cultures
Other cultures / investigations
Blood glucose leve
If the systolic BP is below 90mmHg should you call a rapid response?
Yes
When do you repeat the Lactate?
Two Hours
What are some of the risk factors for maternal sepsis?
Recent surgery, procedure, wound
At risk of intrauterine infection (prolonged rupture of membranes, prolonged labour, retained products of conception, fetal tachycardia)
Immunocompromised, chronic illness
Indwelling medical device or line
Iron-deficiency anaemia
Unwell children, household members Concern by woman, family, clinician Aboriginal and Torres Strait Islander people
What is the preferred terminology used
a) Moderate or Severe Sepsis
or
b) Probable or Possible Sepsis
b) Probable or Possible Sepsis
How many attempts should you have at cannulation before you should escalate to someone else?
Two
Where do you find the Therapeutic Guidelines : Antibiotics?
Embedded in the Pathway and on the ISLHD Intranet
Where is the sepsis kit kept?
(Dependent on group)
Is Concern by woman or family considered a risk for maternal sepsis?
Yes
Risk of women, family or clinician
Who should be involved in a management plan discussion?
If they are on Antibiotics should you still collect blood cultures?
Yes you do
If ongoing hypotension what should you consider doing ?
Commence Vasopressors and escalate to ICU (Rapid Response)
What ongoing observations are recommended?
Minimum of 30 minutely for 2 hours then 4 hourly
Can Maternal Sepsis present with vague and non-specific symptoms?
Yes
Should an Advanced Care Plan be considered when managing Maternal Sepsis?
Yes
What microbiological samples should you consider collecting for a Maternal Sepsis?
Urine
Vaginal Swab
Breast milk
Stool
Wound
Throat
Should all suspected Maternal Sepsis have an IDC?
It is recommended
Where and who should document the sepsis management plan?
The MO should document the Sepsis management plan