Sepsis following pregnancy

This guideline from the RCOG covers management of post-natal sepsis (i.e. in the first 6/52 after delivery).

Causes of sepsis following pregnancy

In women presenting with infection postnatally, especially consider the following possible causes:

  • UTI
  • Endometritis
  • Cellulitis (eg around cannulas or caesarean section scars)
  • Mastitis
  • Necrotising fasciitis (beware excruciating pain with little outward sign of a problem)

Red flags in the postnatal period

The advice is that if any of these are present, the lady should be referred back to hospital:

  • Temp > 38
  • Pulse > 90
  • RR > 20
  • Abdo / chest pain
  • Diarrhoea and/or vomiting
  • Uterine or renal angle pain
  • Generally unwell or undue anxiety or distress

Contacts of Group A Sepsis

  • Normally chemoprophylaxis would be used only if there had been 2 or more cases. In post-natal or neonatal cases, only 1 case is needed before chemoprophylaxis is advised. Close contacts would be treated (e.g. members of same household, boyfriends and girlfriends, students sharing a dormitory or university students sharing a kitchen). Normally close contacts would be identified and contacted by HPA / microbiology. What antibiotic is used will depend on sensitivities etc in the case, so seek advice.
  • Healthcare workers only need chemoprophylaxis if there has been direct contamination (e.g. needlestick/respiratory droplets).

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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