Читать книгу Managing Medical and Obstetric Emergencies and Trauma - Группа авторов - Страница 39

In 1982–1984, there were only nine deaths from this cause and none was due to puerperal sepsis. Deaths from sepsis subsequently rose steadily. In 2006–2008 it became the leading direct cause of maternal death with 26 deaths. Thirteen of these were due to the group A beta‐haemolytic Streptococcus (S. pyogenes), compared with four in 2016–2018. Among a total of 10 women who died from genital tract sepsis in 2016–2018, six died after mid‐trimester chorioamnionitis from Escherichia coli; three of these six women had preterm pre‐labour rupture of the membranes. This highlights the high‐risk nature of mid‐trimester rupture of membranes, and the 2020 report emphasises the importance of early senior involvement in the care of women with extremely preterm pre‐labour rupture of membranes and a full explanation of the risks and benefits of continuing the pregnancy.

Sepsis is often insidious in onset and can progress very quickly. If it is suspected, urgent referral to hospital is necessary. In hospital, high‐dose broad‐spectrum antibiotics should be started immediately, without waiting for the results of investigations. In 2012, in response to the rise in deaths, the RCOG published new guidelines on bacterial sepsis during and after pregnancy.

Sepsis due to respiratory causes remains a leading cause of death during or after pregnancy, as was evident in the 2009 AH1N1 influenza pandemic, and the covid‐19 pandemic has highlighted this once again. Over the first wave of the covid‐19 pandemic in the UK, 10 women died with SARS‐CoV‐2 infection, of whom eight died from complications of covid‐19. A rapid report from MBRRACE‐UK (Saving Lifes, Improving Mothers’ Care Rapid Report: Learning from SARS‐CoV‐2‐related and associated maternal deaths in the UK March–May 2020) noted that the severity of women’s illnesses was often not recognised until they were in extremis, and emphasised the importance of multidisciplinary team care and obstetric leadership with daily review. This is essential in order to ensure timely recognition of deterioration, early assessment of the need for iatrogenic birth to help respiratory function and identification of postnatal complications.

It is also important to remember that deaths from influenza continue to occur despite widespread availability of vaccination. With immunisation rates in pregnancy at less than 50%, influenza remains a threat and influenza swabs should still be taken in women presenting with severe upper respiratory tract infections, with antiviral treatments commenced until results exclude it.