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7.5 Clinical issues and presentation
ОглавлениеMinimising risk from infection in the antenatal period, by avoiding unnecessary vaginal examinations and paying attention to hygiene, may reduce the incidence of sepsis. Early recognition and increased surveillance of those at risk including careful assessment of postnatal mothers, especially those with prolonged rupture of membranes, ragged membranes or possible incomplete delivery of the placenta and women with uterine tenderness or enlargement, will help to identify women developing serious infection. Multiple presentations should be seen as a red flag and requires careful review with escalation to senior staff for assessment.
Symptoms of sepsis may include:
Feeling unwell, anxious or distressed
Shivery or feverish
Sore throat, cough or influenza‐like symptoms (pneumonia accounts for a significant number of admissions to the intensive care unit in pregnant women in the antenatal period)
Rash (see Appendix 7.1 for weblink to assessment of pregnant woman reporting viral rash illness)
Chest pain
Vomiting and/or diarrhoea
Abdominal pain, uterine and renal angle pain, and beware ‘after pains’ of a severity that is out of proportion to the known cause and not responding to usual analgesia
Wound tenderness
If pregnant may report reduced fetal movements
Offensive vaginal discharge
Persistent vaginal bleeding may be a sign of uterine sepsis
Breast tenderness, suggesting mastitis
Headache
Unexplained physical symptoms
A high index of suspicion and close surveillance will help in identifying women with early sepsis. When assessing a woman who is unwell, revisit the history and consider her clinical condition in addition to the modified early obstetric warning score (MEOWS) and do not be reassured by a single set of observations on the MEOWS chart (Knight et al., 2017). Chronic illness and immunosuppression are risk factors for sepsis. Immunosuppression puts a woman at higher risk of rapid deterioration from sepsis, and sepsis should be considered a likely cause when they are unwell.
Serious clinical signs can be categorised as red and amber flags.
The Sepsis Trust UK Sepsis Screening Tool for Acute Assessment of the pregnant or up to 6 weeks’ post‐pregnancy woman is reproduced in Figure 7.2 and defines the red and amber flags.
Figure 7.2 Sepsis Trust UK Sepsis Screening Tool for Acute Assessment
Source: Nutbeam T, Daniels R on behalf of the UK Sepsis Trust. © 2019 UK Sepsis Trust