Danger, Will Robinson!
Intercellular signaling proteins that mediate endothelial nitric oxide production and inhibit myocardial contractility
What are cytokines?
3 key delays associated with maternal death
What are: delays in recognition, delays in treatment, and delays in escalation of care?
Time frame within which patients with a high clinical suspicion of sepsis/septic shock should receive broad-spectrum antibiotics
What is within 1 hour of presentation?
Percentage of septic pregnant or postpartum patients without fever or hypothermia
What is 20-25%
According to the authors, these are the warning signs most important for patient education (4 of 5)
What are (1) fever and chills, (2) fatigue (inability to perform ADL), (3) severe pain (not managed by pain medication), (4) shortness of breath, and (5) fast heart rate?
Two factors required for a diagnosis of septic shock
What are (1) use of vasopressors and (2) elevated serum lactate (>2mmol/L)?
Clearly the best published screening tool for identifying obstetric patients with sepsis
What is there is no single best tool?
Resuscitative fluid administration should be given with goal of achieving a mean arterial blood pressure (MAP) of this value
What is 65 mmHg?
Reason why passive leg raising may not be a reliable predictor of fluid responsiveness during second half of pregnancy
What is uterine compression of the inferior vena cava limiting cardiac filling after passive leg raising?
Two indications to re-dose cefazolin for infection prevention at time of Cesarean section
What are (1) after 1.5 liters estimated blood loss and (2) length of procedure lasting > 4 hours?
Expression of this protein on the surface of activated inflammatory cells will activate the clotting cascade and lead to thrombotic disseminated intravascular coagulation
What is tissue factor?
According to the Surviving Sepsis Campaign, this screening tool is NOT advised for use in pregnancy.
What is qSOFA (Quick Sequential Organ Failure Assessment)?
If hypotension persists despite fluid administration, this is first-line vasopressor for management of sepsis in pregnancy
What is norepinephrine?
Time frame during which physiologically elevated (during 2nd stage of labor) serum lactic acid levels should return to normal after delivery
What is within 1 hour?
As recommended by the authors, this is the length of time that patients receive screening for depression, anxiety, and posttraumatic stress disorder after sepsis
What is up to 1 year postpartum?
Dysfunction of this organelle can cause cytopathic hypoxia and accumulation of lactic acid
What is the mitochondria?
Proper response to nursing report of difficulty obtaining vital signs
What is bedside evaluation for signs/symptoms of sepsis?
For patients in septic shock (and thus requiring vasopressors), addition of this hormone may result in immunomodulation and faster shock resolution (type of medication and preferred agent)
What are steroids (hydrocortisone generally preferred)?
Reason why delivery for maternal indications is not indicated in the setting of severe respiratory failure secondary to sepsis (except in cases of intrauterine source)
What are no improvement in respiratory function and compliance after delivery?
Reason why the Stop, Look, and Listen patient-centered approach may reduce maternal mortality from sepsis
What is many signs/symptoms of sepsis may overlap with those of normal pregnancy?
3 most common bacterial organisms causing sepsis in pregnancy
What are Escherichia coli, group B streptococcus, and group A streptococcus?
Sepsis accounts for this % of maternal deaths during (1) delivery hospitalization and (2) postpartum readmission (each +/- 5%)
What are 24.4% and 38.4%?
What is 7 g/dL?
For patients in septic shock with indications for induction of fetal lung maturity, this is preferred glucocorticoid
What is betamethasone (or dexamethasone) per current obstetric protocols?
In a Danish population-based study, this is % of patients who were given a prescription for a new psychoactive medication within 3 months after hospitalization if they received mechanical ventilation (+/- 3%).
What is 12.7%?