Risk factors for death in patients with sepsis admitted to an obstetric intensive care unit: A cohort study

Infectious Complications of Abortion

This article reviews the infectious complications of abortion (both spontaneous and induced) and the management of this condition. The key points are: (1) Making abortion illegal does not reduce its incidence or prevalence; rather, it only makes abortions unsafe, increasing the likelihood of infectious complications. (2) Timely recognition of developing sepsis in the pregnant patient is critical. This requires constant vigilance and a high index of suspicion. (3) Rapid intravenous administration of broad-spectrum antibiotics targeted to the likely intrauterine source of infection as soon as sepsis is diagnosed is critical to prevent severe sepsis, septic shock, and multisystem organ failure. (4) The mainstay of treatment is prompt evacuation of any residual products of conception from within the uterine cavity under broad-spectrum antibiotic cover targeting the likely intrauterine source of infection. (5) Prompt engagement of specialists in both critical care and obstetrics-gynecology is necessary to optimize outcomes in patients with septic abortion.

Determinants of Survival in obstetric Sepsis: Retrospective Observational Study

Introduction

Sepsis is the dysregulated response of the body to the infection. Obstetric sepsis carries significantly greater morbidity and mortality as the condition is also augmented by the physiological adaptation of body during pregnancy. We conducted this study to determine the various epidemiological and clinical determinants of severity of sepsis which can help in prediction of survival in case of obstetric sepsis.

Materials and Methods

This retrospective study was conducted in a tertiary care center and all cases admitted with the diagnosis of obstetric sepsis as per the defined criteria between January 1, 2016 and December 31, 2020 were included in the study. Patients were evaluated for their clinical presentation, SOFA score, biochemical and microbiological parameters and the treatment given during their course of stay. Variables were compared among survivor and non-survivor group using appropriate statistical tests. Parameters which have significant association were further taken for binary logistic regression analysis.

Result

A total 46 patients of obstetric sepsis were admitted under defined criteria. Twelve out of 46 patients did not survive (26.09%). On statistical analysis, mean SOFA score (p = 0.005) as well as patients with SOFA score > 6 (p = 0.029), presence of multi organ failure (0.04) and septic shock (p = 0.012) were found to be significantly associated with mortality.

Conclusion

The study suggests that these determinants of survival should always be evaluated while catering to a patient of obstetric sepsis in order to guide the treatment, prognostication and improving outcome of the patients.