Management of Genital Tract sepsis

Management of Genital Tract Sepsis

DR JUDITH KUNDODYIWA MRCOG Consultant Obstetrician & Gynaecologist

Table of content

1. Definition

2. Risk Factors for genital tract sepsis

3. Measures to reduce risk of genital tract sepsis

4. Signs and symptoms

5. Investigations

6. Treatment

7. Reference

Definition

• Genital tract sepsis is an acute illness resulting from infection of the genital tract within 42 days following childbirth or miscarriage.
• Common pathogens are Group A Haemolytic Streptococcus, Escherichia coli, Pseudomonas, Enterococcus Faecalis, Staphylococcus, Group Haemolytic Streptococcus and Proteus.

RISK FACTORS FOR GENITAL TRACT SEPSIS

• Amniocentesis
• History of pelvic infection/group B streptococcus
• Cervical cerclage
• Prolonged rupture of membranes
• Prolonged labour
• Caesarean section
• Wound haematoma
• Retained products of conception
• Manual removal of placenta
• Obesity
• Diabetes

MEASURES TO REDUCE RISK OF GENITAL TRACT SEPSIS

• In early pregnancy care should be taken to ensure the uterus is empty following a surgical evacuation of uterus.
• Screening for infection and/or antibiotic prophylaxis is recommended in women undergoing termination of pregnancy.
• Cervical cerclage, though indicated in certain circumstances remains a potential portal of infection in pregnancy. Women undergoing this procedure should be monitored closely and vaginal/cervical swabs obtained if any symptoms develop.

SIGNS AND SYMPTOMS

• In late pregnancy, genital tract sepsis is a differential diagnosis to consider in women presenting with symptoms suggestive of an abruption.
• Sepsis should be considered as a possible diagnosis in all recently delivered women who report symptoms of feeling unwell with a temperature.
• Most of the signs and symptoms are non-specific and unless there is a high index of suspicion, the diagnosis could be delayed or even missed. A detailed history and examination will help in reaching a diagnosis.
• Tachycardia > 100bpm, and unusually severe abdominal pain should prompt urgent medical review.
• Severe sepsis is a cascade of physiological processes in response to an adverse insult to the body. Severe sepsis with acute organ dysfunction has a 20-40% mortality rate. If septic shock occurs, the mortality rate rises.

INVESTIGATIONS

• Bloods – FBC, CRP, coags, U+Es, LFTs, Lactate
• Blood cultures
• Blood gases (if septic shock suspected)
• Triple swabs
• Urine culture
• Wound swabs (if applicable)
• Pelvic USS

TREATMENT

Remember SEPSIS 6 – guideline

• If genital tract sepsis is suspected, early treatment with high dose broad spectrum antibiotics can be life-saving.
• Once investigations have been carried out- Commence Cefuroxime 1.5g and Metronidazole 500mg TDS Intravenously.

*DO NOT WAIT FOR MICROBIOLOGY RESULTS BEFORE ADMINISTERING BROAD SPECTRUM ANTIBIOTICS*

• Monitor vital signs using the Early Warning Score (EWS) to detect any deterioration in clinical condition and possible need for transfer to HDU/ITU
• Request review by Consultant Obstetrician as soon as possible
• The Consultant Microbiologist should be involved at an early stage and appropriate antibiotics commenced once results become available
• Involve other clinical specialities at an early stage as time is of the essence in managing critically ill patients
• Other Measures
  • Antipyretics
  • Analgesia
  • Intravenous fluids
  • Surgical evacuation/wound debridement as required

Reference