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7.5 Clinical issues and presentation

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Minimising 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

Managing Medical and Obstetric Emergencies and Trauma

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