Maternal Sepsis Pathway
Is sepsis a medical emergency?
YES
When is it appropriate to use the Neonatal Sepsis Pathway?
For neonates up to 28 days in any clinical setting.
Name 3 signs or symptoms that could indicate maternal sepsis.
- back pain
- unexplained abdominal pain
- vomiting/diarrhoea
- change in mental status
- rigors/fevers
- flu-like symptoms
- breast/wound redness or swelling
- dysuria, oliguria, frequency, odour
If someone asks 'Could it be sepsis?', what should be your response?
Listen
Look
Act
What are the actions included in the 'Resuscitate' section of the Maternal Sepsis Pathway?
1. Get Help
2. Commence monitoring
3. Obtain access and collect pathology
4. Commence fluid resuscitation
5. Commence antibiotics
Name 3 risk factors for maternal sepsis.
- recent surgery/procedure/wound
- risk of intrauterine infection (PROM, prolonged labour, retained products, fetal tachycardia
- immunocompromised/chronic illness
- IDC or IVC
- Fe deficiency anaemia
- unwell household members
- concern by family or clinician
- Aboriginal/Torres Strait Islander descent
What are 3 signs/symptoms that may alert you to possible neonatal sepsis?
- temperature instability
- pale/mottled/central cyanosis
- lethargy, poor feeding, poor tone
- new or worsening respiratory distress
- new rash
- red umbilicus
- abnormal movement (seizures)
- high pitched cry, irritability, increased tone, jitteriness
- Abdominal distension/tenderness
- diarrhoea, blood in stool
What are your actions for a red zone breach in the ISLHD Maternity Service
Rapid Response
Tier 1 - within 15 minutes
Tier 2 - immediate
How many people develop sepsis every year?
a. 15,000
b. 30,000
c. 55,000
d. 82,000
55,000 people develop sepsis every year
What pathology is collected on the Maternal Sepsis Pathway?
Lactate
FBC/UEC/LFT's/Fibrinogen/Coagulation screen/VBG and CRP
Blood cultures
Swabs/MSU
Blood Glucose Level
On the Maternal Sepsis Pathway - What are the 4 sections?
Recognise
Respond and Escalate
Resuscitate
Reassess and Review
What are 2 maternal risks factors that are recognised as risk factors on the Neonatal Sepsis Pathway?
PROM
Maternal pyrexia (above or equal to 38 degrees
Maternal infection
GBS
Bacterial growth on a placental swab
How many people die from sepsis related complications each year in Australia?
a. 1,400
b. 8,000
c. 1,250
d. 2,100
8,000 of the 55,000 people that develop sepsis each year in Australia, die from sepsis related complications.
In the 'Commence Fluid Resuscitation' section of the Maternal Sepsis Pathway what is recommended to be given as a bolus?
1000mL Sodium Chloride 0.9% STAT
What Zone is a Maternal Temperature of 38.3 degrees on the Standard Maternal Observation Chart (SMOC)
Yellow Zone
You use the Maternal Sepsis Pathway from 12 weeks pregnant to 6 weeks postpartum.
TRUE or FALSE
FALSE - You use the Maternal Sepsis Pathway for all pregnant women and up to 6 weeks postpartum, including perinatal loss, in any clinical setting to support the recognition and management of sepsis.
In the 'Resuscitation' section of the Neonatal Sepsis Pathway - What pathology should be collected?
Blood Cultures
Blood Gas
Lactate
Blood Glucose Level
What would be your action if a woman on the sepsis pathway had a lactate of 5mmol/L?
Rapid Response and refer to the Resuscitation plan.
This woman has PROBABLE SEPSIS with a high risk of deterioration and SEPTIC SHOCK.
Where do you find information about the Sepsis Kills Program?
- The Clinical Excellence Commission (CEC) website
- ISLHD webpage
What are the recommended actions if there is ongoing hypotension?
Consider commencement of vasopressors and escalate to Intensive Care or Retrieval service.
In the 'Resuscitate' section of the Maternal Sepsis Pathway what are 2 recommended actions that you should undertake in the first 5 minutes?
1. Get help, escalate as per local CERS, consult with obstetrician/senior clinician
2. Give oxygen as required to maintain SpO2 of 95% or above
In the 'Reassess' section of the Neonatal Sepsis Pathway what ongoing monitoring is recommended?
Continue to monitor vital sign observations at a minimum frequency every 30 minutes for 2 hours, then hourly for 4 hours.
When a woman is on the Maternal Sepsis Pathway how long do you continue to monitor her vital signs and fluid balance?
Minimum of every 30 minutes for 2 hours and then hourly for 4 hours. Escalate to CERS if any signs of deterioration.
Where can I find learning modules on Sepsis?
My Health Learning
In the 'Reassess' section of the Maternal Sepsis Pathway, what timeframe is recommended for a repeat lactate?
Within 2 hours