Physiological Shifts
A normal physiological shift in pregnancy causes this vital sign to increase by 15-20 bpm, often masking early tchycardic responses to sepsis
What is resting maternal heart rate?
What is are you currently pregnant or have you delivered in the last 6 weeks?
In maternal sepsis guidelines, a serum level of this metabolic byproduct higher than 2.0 mmol/L serves as a critical red flag for tissue hypoperfusion.
What is lactic acid (lactate)?
In a department without continuous EFM, ACOG and AWHONN agree that this handheld bedside device is the primary tool used in the ER to confirm fetal life and baseline heart rate.
What is a handheld acoustic/fetal Doppler?
Even when preparing a patient for immediate flight or ground transfer, empiric broad-spectrum antibiotics must be hung and initiated in the CAH within this critical time frame.
What is 3 hours of first vitals?
Due to progesterone stimulating the respiratory center, a pregnant patient's baseline respiratory rate runs slightly higher, making this adult sepsis marker easy to overlook
What is tachypnea? (respiratory rate > 20 breaths/min)
What is fundal height.
While a white blood cell (WBC) count above 12,000/µL flags infection in a standard adult, a normal pregnant patient can comfortably baseline at this level
What is 15,000 to 16,000/µL? In some patients this it can climb to 25,000
When evaluating a fetus via handheld Doppler, a baseline fetal heart rate consistently exceeding this many beats per minute indicates fetal tachycardia, often driven by maternal fever or early hypoxemia.
What is 160 bpm?
If the septic pregnant patient requires blood pressure support before or during transport, this medication remains the first-line vasopressor of choice, as it preserves placental perfusion better than dopamine.
What is norepinephrine?
A drop in systemic vascular resistance causes this vital sign to normally decrease during the second trimester, mimicking or obscuring early distributive shock.
What is blood pressure (specifically diastolic BP)?
If patient is more comfortable lying down, this position helps support the pregnant patient and fetus's perfusion.
What is a lateral tilt (either direction)?
Sepsis-induced DIC must be evaluated with pregnancy-specific baselines because pregnancy is naturally a state of hypercoagulability, meaning this common clotting factor baseline is normally elevated (ranging from 300–600 mg/dL).
What is fibrinogen?
If an ER nurse performs a Doppler check and notes a baseline fetal heart rate below 110 bpm lasting for more than 10 minutes, this life-threatening fetal emergency is occurring, necessitating an immediate "load-and-go" transfer.
What is fetal bradycardia (prolonged deceleration)?
To prevent profound hypoperfusion during a lengthy transport, maternal fetal medicine recommends an initial rapid crystalloid fluid challenge of this volume for maternal hypotension or lactate 2.0.
What is 1 to 2 Liters (or 30/mL/kgs)? Which matches our non-pregnant patient protocol.
Because a pregnant patient's blood volume increases by up to 50%, they can lose a massive amount of intravascular volume before displaying this classic late sign of septic shock.
What is hypotension?
Pregnant patient presents in Triage and vital signs HR of 115, BP 89/48, SPO2 92% on RA, temp of 37.9 would place this patient in this ESI score?
Due to normal gestational respiratory alkalosis, a pregnant patient's baseline pCO2 runs lower (28–32 mmHg), meaning an arterial blood gas reading showing a "normal" adult pCO2 of 40 mmHg actually signifies this critical state.
What is respiratory failure (or hypoventilation/retention of CO2/Respiratory Acidosis)?
Because continuous monitoring is unavailable, AJOG literature suggests CAH emergency staff perform intermittent Doppler checks at this frequency interval during active resuscitation of a critically ill mother.
What is every 15 to 30 minutes (or following any major maternal intervention/medication change)?
To maintain adequate oxygen delivery across the placenta during transfer, supplemental maternal oxygenation should be titrated to keep pulse oximetry (SpO2) at or above this percentage.
What is 95%?
Studies show that up to 20–25% of pregnant patients dying of sepsis never actually developed this common infectious symptom, meaning its absence cannot rule out infection
What is a fever (or pyrexia)?
When assessing fetal heart tones the RN should listen and count for this length of time.
What is one minute?
Before starting empiric broad-spectrum antibiotics, the ER nurse must draw these diagnostics within the 3 hours of the first set of vital signs.
What are blood cultures (and/or urine/respiratory cultures)?
Per policy this is the gestational age would warrant a transfer to an OB capable facility.
What is gestational age of 20 weeks or greatef?
Per maternal fetal medicine and ACOG guidelines, delaying a critical transfer to perform an emergency delivery at a non-OB facility is highly discouraged because of this.
What is "stabilization of the mother is the best way to stabilize the fetus"? (The mother is the fetus's "ICU").