Genital tract sepsis: Specific recommendations (7, page 97)
All health professionals must be aware of the symptoms and signs of maternal sepsis and critical illness and of the rapid, potentially lethal course of severe sepsis and septic shock:
Maternal tachycardia, constant severe abdominal pain and tenderness are important early features of genital tract sepsis that should prompt urgent medical review.
All maternity units should have guidelines for the investigation and management of genital tract sepsis.
If sepsis is suspected, regular frequent observations should be made and use of the Modified Early obstetric Warning core (MEOWS) as recommended by this Report is crucial.
High dose broad-spectrum intravenous antibiotic treatment should be started immediately sepsis is suspected, without waiting for microbiology results.
Learning points: Puerperal sepsis (7.4, page 102)
Any problems noted during a womanâ€™s hospital stay should be reported directly to her community carers (GP, midwives and health visitors) when she is discharged in order that appropriate follow up visits may be arranged and the significance of developing symptoms recognised.
Early discharge means that some women will develop complications after they return home.
Routine observations of pulse, BP, temperature, respiratory rate, and lochia should be made in all recently delivered women for several days postpartum.
Sepsis is often insidious in onset with a fulminating course. The severity of illness should not be underestimated. Community midwives and GPs need to be vigilant and visit regularly. Early referral to hospital may be life saving.
Sepsis should be considered in all recently delivered women who feel unwell and have pyrexia.
Health Protection Agency
Royal College of Obstetricians and Gynaecologists
Recommendations for education and health policy
- Puerperal sepsis is not a disease of the past and general practitioners and midwives must be aware of the signs and be prepared to institute immediate treatment and referral of any recently delivered woman with a fever and/or offensive vaginal discharge.
- Clinicians must remain vigilant for early signs of invasive streptococcal disease. The signs of necrotising fasciitis are high fever plus swelling and marked tenderness localised to a muscle mass. Early treatment with antibiotics still seems to be the best way to prevent death.
- Over 150,000 women die each year from puerperal sepsis. Medical treatment is often straightforward and inexpensive. Urgent action is needed by governments to make treatment available and accessible.