Sepsis in Obstetrics
The Surviving Sepsis Campaign (Rhodes et al., 2017) has brought the issue to the forefront of inpatient care. Clinical teams in hospitals and healthcare systems are developing plans to recognize and treat sepsis in a timely manner. Sepsis in obstetric patients may have an altered presentation. Indicators such as vital sign parameters are significantly different than the general population. For example, a heart rate over 100 beats per minute (bpm) in the general population is a trigger for sepsis, whereas in the obstetrical population the trigger is 110 bpm. Fetal tachycardia greater than 160 bpm and Triple I (formerly known as chorioamnionitis) are likewise triggers for sepsis. Identification of these triggers are key to early detection (Shields, Wiesner, Klein, Pelletreau, & Hedriana, 2016).
Sepsis Rapid Response Teams are being developed in many hospital systems. It is important for all members of the team to know and understand how key indicators differ in the obstetric population. Tools such as the Maternal Early Warning Trigger tool may help nurses identify early warning triggers for maternal sepsis (Shields et al., 2016). The Surviving Sepsis Campaign published new 2016 guidelines in January of 2017. These guidelines are significantly different than the 2012 guidelines based on new evidence from clinical trials and research conducted in the intervening period.
Although each article in this series gives pertinent information, reading all three articles will reveal the broad scope of understanding needed to recognize and treat sepsis. The first article addresses the underlying pathology of sepsis and provides key definitions of related terms. The second article uses a widely publicized case to explore the clinical presentation of a woman who developed sepsis and discusses clinical tools that are available to enhance nurses' recognition of sepsis in the early stages. The third article, also including exemplar cases, focuses on early treatment that is key to survival, prognosis for recovery, and disease prevention. Read in sequence, the articles are designed to give nurses caring for mothers and babies a firm understanding of this critical illness and the knowledge to recognize and intervene rapidly. We hope you will find the information presented useful in your clinical practice.