Post Pregnancy Sepsis

Symptoms of sepsis in the puerperium may be less distinctive than in the non-pregnant population and are not necessarily present in all cases. A high index of suspicion is necessary

Red flag signs and symptoms (see below) should prompt urgent referral for hospital assessment:

  • abdominal or chest pain
  • diarrhoea and/or vomiting
  • uterine or renal angle pain and tenderness
  • woman is generally unwell or seems unduly anxious or distressed
  • Infection, documented or suspected, and some of the following:
    • Fever (> 38°C)
    • Hypothermia (core temperature < 36°C)
    • Tachycardia (> 90 beats/minute)
    • Tachypnoea (> 20 breaths/minute)
    • Impaired mental state, altered conscious level
    • Considerable oedema or positive fluid balance (> 20ml/kg over 24 hours)
    • Hyperglycaemia in the absence of diabetes (plasma glucose > 7.7 mmol/l)
    • Bruising or discoloration of skin suggests late fasciitis (often pain receding as cutaneous anaesthesia supervenes as nerves die)

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Infection must also be suspected and actively ruled out when a recently delivered woman has persistent vaginal bleeding or abdominal pain. If there is any concern, the woman must be referred back to the maternity unit as soon as possible

NOTE:  Mastitis is easily overlooked clinically, but may lead to breast abscesses, necrotising fasciitis and toxic shock syndrome. Immediate referral to hospital is indicated if the woman with mastitis is clinically unwell, if there is no response to oral antibiotics within 48 hours, if mastitis recurs or if there are very severe or unusual symptoms

RCOG Green Top Guidance; Bacterial Sepsis Following Pregnancy

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