ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M.

ISSN: 2789-5009

Leading Ecuadorian research in science, technology, engineering, arts, and mathematics.

Treatment of Sepsis in pregnancy, Childbirth and the Puerperium: Update According to New Evidence

Published date: Sep 09 2021

Journal Title: ESPOCH Congresses: The Ecuadorian Journal of S.T.E.A.M.

Issue title: Volume 1, Issue 6

Pages: 1734–1744

DOI: 10.18502/espoch.v1i6.9665

Authors:

Lino Arturo Rojas Pérezlinoarojas@hotmail.comFacultad de Salud Pública, Carrera de Medicina, Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador

Lino Arturo Rojas CruzFacultad de Salud Pública, Carrera de Medicina, Facultad de Salud Pública, Escuela Superior Politécnica de Chimborazo, Riobamba, Ecuador

María Daniela Villagómez VegaProSalud Medical Center, Jacinto Gonzales 1951 y Rey Cacha, Riobamba, Ecuador

Augusto Ernesto Rojas CruzProSalud Medical Center, Jacinto Gonzales 1951 y Rey Cacha, Riobamba, Ecuador

Andrés Eduardo Rojas CruzProSalud Medical Center, Jacinto Gonzales 1951 y Rey Cacha, Riobamba, Ecuador

Abstract:

Introduction: Sepsis is a pathology that occurs due to a serious infectious process that can lead to death. It is characterized by organic and biochemical changes that determine an exaggerated response of the organism to infection. This infectious process can start anywhere in the body, subsequently causing bacteremia, systemic invasion through the blood, causing failure of multiple organs, and may even lead to the death of the person. Objective: The objective of this work is to describe the management of this pathology, according to the best evidence and above all updated. Methodology: Virtual libraries and scientific information search engines have been used to find the best available and most up-to-date evidence, and to meet the proposed inclusion criteria, in this research process, evidence and recommendations with a high level and scientific support in English or Spanish were used. of the last years. Results: 36 scientific articles were evaluated, such as clinical practice guides, systematic reviews, meta-analyzes, clinical trials, among others, which describes the most current management in a protocolized way. Discussion: Sepsis as a pathology increases maternal and perinatal morbidity and mortality and represents the third cause of maternal death worldwide and at the national level, knowing its proper management will help improve your prognosis and recovery. Conclusion: Since the complications of sepsis can produce multi-organ failure that will compromise maternal and perinatal health, knowledge of the updated management of this pathology is essential.

Keywords: sepsis, septic shock, infection.

RESUMEN

Introducción: La sepsis es una patología que se presenta por un proceso infeccioso grave que puede llevar a la muerte, se caracteriza por alteraciones orgánicas y bioquímicas que determinan una respuesta exagerada del organismo a la infección. Este proceso infeccioso puede iniciarse en cualquier sitio del cuerpo, provocar posteriormente bacteriemia, invasión sistémica a través de la sangre, causando falla de múltiples órganos, y pudiendo inclusive llevar al fallecimiento de la persona. Objetivo: El objetivo de este trabajo es describir el manejo de esta patología, de acuerdo a la mejor evidencia y sobre todo actualizada. Metodología:  Se ha utilizado bibliotecas virtuales y buscadores de información científica para encontrar la mejor evidencia disponible y más actualizada, y que cumplan los criterios de inclusión propuestos, en este proceso investigativo se utilizó evidencias y recomendaciones con un alto nivel y respaldo científico en idioma inglés o español de los últimos años. Resultados: Se evaluaron 36 artículos científicos como guías de práctica clínica, revisiones sistemáticas, metaanálisis, ensayos clínicos, entre otros, que describe en forma protocolizada el manejo más actual. Discusión: La sepsis como patología aumenta la morbimortalidad materna y perinatal y representa la tercera causa de muerte materna a nivel mundial y a nivel nacional conocer su manejo adecuado ayudará a mejorar su pronóstico y su recuperación. Conclusiones: Debido que las complicaciones de la sepsis pueden producir falla multiorgánica que comprometerá la salud materna y perinatal, es fundamental el conocimiento del manejo actualizado de esta patología.

Palabras clave: sepsis, choque séptico, infección.

References:

[1]Schmidt G, Mandel J. Evaluation and management of suspected sepsis and septic shock in adults. UpToDate. 2019. Available from: https://www.uptodate.com/contents/evaluation‐ and‐management‐of‐suspected‐sepsis‐and‐septic‐shock‐in‐adults/print?search=sepsis&source=search_ result&selectedTitle=2~150&usage_type=default&display_rank=2

[2]Tang Y, Choi J, Kim D, et al. Clinical predictors of adverse outcome in severe sepsis patients with lactate 2‐4 mM admitted to the hospital. QJM. 2015;108(4):279–87.

[3]Neviere R. Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis. UpToDate. 2018. Available from: https://www.uptodate.com/ contents/sepsis‐syndromes
‐in‐adults‐epidemiology‐definitions‐clinical‐presentation‐diagnosis‐and‐prognosis/ print?search=sepsis&source=search_result&selectedTitle=1~150&usage_type=
default&display_rank=1

[4]Kalil A. Septic Shock. Practice Essentials. Medscape. 2018. Available from: https:// emedicine.medscape.com/article/168402‐overview#showall

[5]Rudd KE, Seymour CW, Aluisio AR, et al. Association of the quick sequential (sepsis-related) organ failure assessment (qsofa) score with excess hospital mortality in adults with suspected infection in low‐ and middle‐income countries. JAMA. 2018;319(21):2202.

[6]Lamontagne F, Rochwerg B, Lytvyn L, et al. Corticosteroid therapy for sepsis: A clinical practice guideline. BMJ. 2018;362:3284.

[7]Kall A. Septic shock clinical presentation: History, physical examination, complications. Medscape. 2019. Available from: https://emedicine.medscape.com/article/168402‐clinical#showall

[8]Kall A. Septic shock differential diagnoses. Medscape. 2019. Available from: https:// emedicine.medscape.com/article/168402‐differential

[9]Fang F, Zhang Y, Tang J, et al. Association of corticosteroid treatment with outcomes in adult patients with sepsis. JAMA Intern Med. 2019;179(2):213.

[10] Bokhari AM. Bacterial Sepsis: Practice Essentials, Background, Etiology. Medscape. 2019. Available from: https://emedicine.medscape.com/article/234587‐overview#showall

[11] Arroyo K, Carreño M, Ocampo J. Prevención, diagnóstico y tratamiento de la sepsis materna. Guía de evidencias y recomendaciones: Guía de práctica clínica. Vol. 1. CENETEC. México: CENETEC; 2018. 1–41 p. Available from: http://www.cenetec‐difusion.com/CMGPC/GPC‐IMSS‐272‐18/ER.pdf

[12] Calle J, Ríos P, Yuen Chon V, Rojas L, Rivadeneira J, Pareja C. Score MAMÁ y claves obstétricas. Protocolo. Primera Ed. Quito: Gerencia Institucional de Implementación de Disminución Mortalidad Materna. Ministerio de Salud Pública del Ecuador; 2017.

[13] WHO. Statement on Maternal Sepsis. World Health Organisation; 2017. Available from: www.who. int/reproductivehealth

[14] Kall A. Septic shock: Practice essentials, background, pathophysiology. Medscape. 2019. Available from: https://emedicine.medscape.com/article/168402‐overview#showall

[15] Bowyer L, Robinson H, Angela M, et al. SOMANZ Guidelines for the investigation and management of sepsis in pregnancy. 2017. Available from: https://www. somanz.org/downloads/2017SepsisGuidelines.pdf

[16] Gaieski D, Mikkelsen M. Definition, classification, etiology, and pathophysiology of shock in adults. UpToDate. 2018. Available from: https://www.uptodate.com/contents/definition‐ classification‐etiology‐and‐pathophysiology‐of‐shock‐in‐adults/print?search=choque&source=search_ result&selectedTitle=1~150&usage_type=default&display_rank=1

[17] Shankar‐Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: Third international consensus definitions for sepsis and septic shock (Sepsis‐3). JAMA. 2016;315(8):775.

[18] Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsisand septic shock (Sepsis‐3). JAMA. 2016;315(8):801–10.

[19] Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (Sepsis‐3). JAMA. 2016;315(8):762–74.

[20] Koyama SI, Yamaguchi Y, Gibo K, Nakayama I, Ueda S. Use of prehospital qSOFA in predicting in‐hospital mortality in patients with suspected infection: A retrospective cohort study. PLoS One. 2019 [cited 2019 May 12]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504075/pdf/pone.0216560.pdf

[21] Bauer K. Maternal adaptations to pregnancy: Hematologic changes. UpToDate. 2018. Available from: https://www.uptodate.com/contents/maternal‐adaptations‐to‐pregnancy‐ hematologic‐changes/print?sectionName=PLASMA VOLUME&search=cambios fisiologicos en el embarazo&topicRef=443&anchor=H1549271045&source=see_link

[22] Foley M. Maternal adaptations to pregnancy: Cardiovascular and hemodynamic changes. UpToDate. 2017. Available from: https://www.uptodate.com/contents/maternal‐adaptations‐to‐pregnancy‐ cardiovascular‐and‐hemodynamic‐changes/print?search=cambios fisiologicos en el embarazo&source=search_ result&selectedTitle=1~150&usage_type=default&display_rank=1

[23] Prevención, Diagnóstico y Tratamiento de la sepsis materna. Guía de referencia rápida: Guía de Práctica Clínica. 2018. Available from: http://www.cenetec‐difusion.com/CMGPC/GPC‐ IMSS‐272‐18/RR.pdf

[24] Morgan J, Roberts S. Maternal Sepsis. Obstet Gynecol Clin North Am. 2013;40(1):69–87.

[25] Albright CM, Mehta ND, Rouse DJ, Hughes BL. Sepsis in Pregnancy: Identification and Management. J Perinat Neonatal Nurs. 2016;30(2):95–105. Available from: https://www.ncbi.nlm.nih. gov/pubmed/26825620

[26] Kall A. Septic shock treatment & management: Approach considerations, general treatment guidelines in septic shock, goals of hemodynamic support. Medscape. 2019. Available from: https:// emedicine.medscape.com/article/168402‐treatment#showall

[27] Clardy P, Reardon C. Critical illness during pregnancy and the peripartum period. UpToDate. 2019. Available from: https://www.uptodate.com/contents/critical‐illness‐during‐pregnancy‐and‐the‐ peripartum‐period/print?search=sepsis&topicRef=1613&source=see_link

[28] Schmidt GA, Mandel J. Evaluation and management of suspected sepsis and septic shock in adults. UpToDate. 2018. Available from: https://www.uptodate.com/contents/evaluation‐and‐management‐of‐suspected‐ sepsis‐and‐septic‐shock‐in‐adults/print?search=sepsis&source=search_result&selectedTitle=2~150&usage_ type=default&display_rank=2

[29] Cordioli R, Cordioli E, Negrini R, Silva E. Sepsis and pregnancy: Do we know how to treat this situation? Rev Bras Ter Intensiva. 2013.

[30] Spera AM, Bianco V, Simeone D, Viceconte G, Tosone G, Orlando R. Sepsis in pregnant and puerperal women living in high income countries: An update for clinicians. J Gynecol Obstet. 2017.

[31] Tita A. Intra‐amniotic infection (clinical chorioamnionitis or triple I). UpToDate. 2019. Available from: https://www.uptodate.com/contents/intra‐amniotic‐infection‐clinical‐chorioamnionitis‐or‐ triple‐i/print?sectionName=Antibiotic therapy&search=gentamicina&topicRef=475&anchor=H15&source=see_ link

[32] Howell MD, Davis AM. Management of sepsis and septic shock. JAMA. 2017;317(8):847–8.

[33] Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304–77.

[34] Andriolo BN, Andriolo RB, Salomão R, Atallah ÁN. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane database Syst Rev. 2017;1(1):CD010959.

[35] Kaufman D, Mancebo J. Glucocorticoid therapy in septic shock. UpToDate. 2018. Available from: https://www.uptodate.com/contents/glucocorticoid‐therapy‐in‐septic‐shock/ print?search=sepsis&topicRef=1613&source=see_link

[36] Committee on Obstetric Practice. Antenatal corticosteroid therapy for fetal maturation. Acog Committee Opinion. Am Coll Obstet Gynecol. 2017;102–9.

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