alexa Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes.
Anesthesiology

Anesthesiology

Journal of Anesthesia & Clinical Research

Author(s): Snyder CC, Barton JR, Habli M, Sibai BM

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Abstract OBJECTIVE: To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock. METHODS: We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher's Exact and Mann-Whitney U tests. RESULTS: Pyelonephritis was the most common etiology overall (37\%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50\%) and septic shock (80\%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p ≤ 0.001), total bilirubin >4 mg/dl (p = 0.04), failure in ≥3 organ systems (70\% vs. 15\%, p = 0.005), and maternal death (30\% vs. 0\%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40\% with severe sepsis. 71\% of viable pregnancies required emergent cesarean delivery, and 50\% of these for worsening respiratory function. CONCLUSIONS: ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery. This article was published in J Matern Fetal Neonatal Med and referenced in Journal of Anesthesia & Clinical Research

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