Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes
| Autor: | Baha M. Sibai, John R. Barton, Candice C. Snyder, Mounira Habli |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
medicine.medical_specialty ARDS Multiple Organ Failure law.invention law Pregnancy Internal medicine Sepsis medicine Humans Intensive care medicine Retrospective Studies Disseminated intravascular coagulation Respiratory Distress Syndrome Pyelonephritis Septic shock business.industry Cesarean Section Pregnancy Outcome Obstetrics and Gynecology Retrospective cohort study Bilirubin Disseminated Intravascular Coagulation medicine.disease Delivery Obstetric Intensive care unit Shock Septic Pregnancy Complications Shock (circulatory) Pediatrics Perinatology and Child Health Etiology Maternal Death Female medicine.symptom business |
| Zdroj: | The journal of maternal-fetalneonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 26(5) |
| ISSN: | 1476-4954 |
| Popis: | To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock.We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher's Exact and Mann-Whitney U tests.Pyelonephritis was the most common etiology overall (37%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50%) and septic shock (80%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p ≤ 0.001), total bilirubin4 mg/dl (p = 0.04), failure in ≥3 organ systems (70% vs. 15%, p = 0.005), and maternal death (30% vs. 0%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40% with severe sepsis. 71% of viable pregnancies required emergent cesarean delivery, and 50% of these for worsening respiratory function.ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery. |
| Databáze: | OpenAIRE |
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