Progress in early recognition of sepsis during gestational period and puerperium

doi:10.3877/cma.j.issn.2096-1537.2021.04.004

Abstract

Abstract:

Sepsis during gestational period and puerperium is an important cause of maternal death. Due to the special physiology of this population, there is still no uniform standard for the early recognition and diagnosis of sepsis during pregnancy and puerperium worldwide. Therefore, the diagnosis and treatment of sepsis in this population is relatively lagging, which is one of the reasons for its poor prognosis. This article reviews the relevant literature to review the early identification, risk factors and management of sepsis during gestational period and puerperium, so as to strengthen the early recognition of sepsis during gestational period and puerperium.

Key words: Gestational period, Puerperium, Maternal, Sepsis, Obstetrics infection

Dongxu Zhou, Dayan Yang, Tao Wang. Progress in early recognition of sepsis during gestational period and puerperium[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(04): 304-308.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.04.004

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I04/304

Figures/Tables 2

References 29

1	Perner A, Cecconi M, Cronhjort M, et al. Expert statement for the management of hypovolemia in sepsis [J]. Intensive Care Med, 2018, 44(6): 791-798.
2	Prescott HC, Angus DC. Postsepsis morbidity [J]. JAMA, 2018, 319(1): 91.
3	Reinhart K, Daniels R, Kissoon N, et al. Recognizing sepsis as a global health priority - a WHO resolution [J]. N Engl J Med, 2017, 377(5): 414-417.
4	Martin GS, Mannino DM, Eaton S, et al. The epidemiology of sepsis in the United States from 1979 through 2000 [J]. N Engl J Med, 2003, 348(16): 1546-1554.
5	WHO. Shining a spotlight on maternal and neonatal sepsis: World Sepsis Day 2017 [Z/OL]. (2017-9-12)[2018-10-20]. URL
6	Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis [J]. Lancet Glob Health, 2014, 2(6): e323-333.
7	Kumar A, Roberts D, Wood KE, et al . Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock [J]. Crit Care Med, 2006, 34(6): 1589-1596.
8	Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [J]. JAMA, 2016, 315(8): 801-810.
9	Shankar-Hari M, Phillips GS, Levy ML, et al. Sepsis Definitions Task Force. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) [J]. JAMA, 2016, 315(8): 775-787.
10	Bonet M, Nogueira Pileggi V, Rijken MJ, et al. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation [J]. Reprod Health, 2017, 14(1): 67.
11	Bowyer L, Robinson HL, Barrett H, et al. SOMANZ guidelines for the investigation and management sepsis in pregnancy [J]. Aust N Z J Obstet Gynaecol, 2017, 57(5): 540-551.
12	Chebbo A,Tan S,Kassis C,et al. Maternal sepsis and septic shock [J]. Crit Care Clin, 2016, 32(1): 119-135.
13	樊尚荣. 产科重症感染的多学科防治 [J/CD]. 中华产科急救电子杂志, 2017, 6(3): 129-132.
14	张惜阴. 实用妇产科学 [M]. 北京: 人民卫生出版社, 2003: 467.
15	Acosta CD, Bhattacharya S, Tuffnell D, et al. Severe maternal sepsis: identifying actions to address morbidity and mortality. In Knight M,Acosta C,Brocklehurst P,et al eds. Beyond maternal death: improving the quality of maternal care through national studies of 'near-miss'maternal morbidity [J]. Programme Grants Appl Res, 2016, 4(9): 41-64.
16	刘平, 樊尚荣. 妊娠期和产褥期脓毒症 [J]. 中华产科急救电子杂志, 2013, 2(4): 253-256.
17	陈磊, 刘朝晖. 绒毛膜羊膜炎的致病菌及药敏分析 [J]. 中国妇产科临床杂志, 2016, 17(2): 140-143.
18	Pollard K. The fundamental skills: reducing maternal morbidity and mortality [J]. Pract Midwife, 2017, 20(3): 23-25.
19	Albright CM, Has P, Rouse DJ, et al. Internal validation of the sepsis in obstetrics score to identify risk of morbidity from sepsis in pregnancy [J]. Obstet Gynecol, 2017, 130(4): 747-755.
20	Rajkumari N, Mathur P, Sharma S, et al. Procalcitonin as a predictor of sepsis and outcome in severe trauma patients: a prospective study [J]. J Lab Physicians, 2013, 5(2): 100-108.
21	Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis [J]. Lancet Infect Dis, 2013, 13(5): 426-635.
22	Shirakawa K, Furusako S, Endo S, et al. New diagnostic marker for Sepsis: soluble CD14 subtype [J]. J Crit Care, 2004, 8(Suppl 1): P19l.
23	Shozushima T, Takahashi G, Matsumoto N, et al. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome [J]. J Infect Chemother, 2011, 17(6): 764-769.
24	Liu B, Chen YX, Yin Q, et al. Diagnostic value and prognostic evaluation of Presepsin for sepsis in an emergency department [J]. Crit Care, 2013, 17(5): R244.
25	Shozushima T, Takahashi G, Matsumoto N, et al. Usefulness of presepsin (sCD14-ST) measurements as a marker for the diagnosis and severity of sepsis that satisfied diagnostic criteria of systemic inflammatory response syndrome [J]. J Infect Chemother, 2011, 17(6): 764-769.
26	Okamura Y, Yokoi H. Development of a point-of-care assay system for measurement of presepsin (sCD14-ST) [J]. Clin Chim Acta, 2011, 412(23-24): 2157-2161.
27	Shallcross LJ, Mentzer A, Rahman S, et al. Cohort study protocol: Bioresource in Adult Infectious Diseases (BioAID) [J]. Wellcome Open Res, 2018, 3: 97.
28	Fleuren LM, Klausch TLT, Zwager CL, et al. Machine learning for the prediction of sepsis: a systematic review and meta-analysis of diagnostic test accuracy [J]. Intensive Care Med, 2020, 46(3): 383-400.
29	Neonatal Sepsis Initiative Working Group. Electronic address: bonetm@who.int.The Global Maternal and Neonatal Sepsis Initiative: a call for collaboration and action by 2030 [J]. Lancet Glob Health, 2017, 5: e390-391.

指标	高于正常值					低于正常值
指标	+4分	+3分	+2分	+1分	0分	+1分	+2分	+3分	+4分
体温（℃）	＞40.9	39~40.9		38.5~38.9	36~38.4	34~35.9	32~33.9	30~31.9	＜30
收缩压（mmHg）					＞90		70~90		＜70
心率（次/分）	＞179	150~179	130~149	120~129	≤119
呼吸频率（次/分）	＞49	35~49		25~34	12~24	10~11	6~9		≤5
脉搏血氧饱和度（%）					≥92	90~91		85~59	＜85
白细胞（×10⁹）	＞39.9		25~39.9	17~24.9	5.7~16.9	3~5.6	1~2.9		＜1
未成熟中性粒细胞（%）			≥10		＜10
血清乳酸（mmol/L）			≥4		＜4

指标	高于正常值					低于正常值
指标	+4分	+3分	+2分	+1分	0分	+1分	+2分	+3分	+4分
体温（℃）	＞40.9	39~40.9		38.5~38.9	36~38.4	34~35.9	32~33.9	30~31.9	＜30
收缩压（mmHg）					＞90		70~90		＜70
心率（次/分）	＞179	150~179	130~149	120~129	≤119
呼吸频率（次/分）	＞49	35~49		25~34	12~24	10~11	6~9		≤5
脉搏血氧饱和度（%）					≥92	90~91		85~59	＜85
白细胞（×10⁹）	＞39.9		25~39.9	17~24.9	5.7~16.9	3~5.6	1~2.9		＜1
未成熟中性粒细胞（%）			≥10		＜10
血清乳酸（mmol/L）			≥4		＜4

指标	红色预警（每项4分）	黄色预警（每项2分）
体温（℃）	＜35或＞38	35~36
收缩压（mmHg）	＜90或＞160	90~100或150~160
舒张压（mmHg）	＞100	90~100
心率（次／分）	＜40或＞120	40~50或100~110
呼吸频率（次／分）	＜35或＞38	21~30
脉搏血氧饱和度（%）	＜95	≥95
疼痛评分（分）	0	2~3
意识状态	无反应	对声音刺激有反应

指标	红色预警（每项4分）	黄色预警（每项2分）
体温（℃）	＜35或＞38	35~36
收缩压（mmHg）	＜90或＞160	90~100或150~160
舒张压（mmHg）	＞100	90~100
心率（次／分）	＜40或＞120	40~50或100~110
呼吸频率（次／分）	＜35或＞38	21~30
脉搏血氧饱和度（%）	＜95	≥95
疼痛评分（分）	0	2~3
意识状态	无反应	对声音刺激有反应

[1]	Jianbiao Meng, Geng Zhang, Yanna Jiao. Exploratory study on early intestinal microecological changes in patients with sepsis-induced myocardial dysfunction [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(04): 279-285.
[2]	Yu Chen, Fang Feng, Lu Zhang, Jian Liu. Bioinformatics analysis to screen key pathogenic genes in septic cardiomyopathy [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(04): 286-291.
[3]	Yuanyuan Han, Sabeiti Reziya, Zhijie Mao, Aierken Mufunayi, Chen Lu, Xiaohong Sang, Mulati Aerman, Li Zhang. Effect of combined blood purification on serum inflammatory cytokines levels and clinical prognosis in patients with sepsis [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(04): 272-278.
[4]	Ling Wei, Hui Li, Yi Chen. Current research status on colonization or infection and mother-to-child transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae in pregnant and post-partum women [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 517-521.
[5]	Haoyuan Yang, Jie Gong, Qingwei Zou, Hang Ruan. Current research status on adverse pregnancy outcomes of maternal and infant in pregnant women with asthma [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 522-529.
[6]	Xiaoyan Zhang, Dongqiong Xiao, Hu Gao, Lin Chen, Fajuan Tang, Xihong Li. The protective effect and mechanism of overexpression of transcription factor 12 on the cerebral cortex of rats with sepsis-associated encephalopathy [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 540-549.
[7]	Xu Wei, Ge Zhang, Jinlin Wu. Monitoring and treatment of neonatal sepsis-induced coagulopathy [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 379-386.
[8]	Xiaodan Wang, Yuan Wang, Xiangyu Cui, Xiaolei Ren. Analysis of pathogenic bacteria resistance of drug and high risk factors of death in urogenic sepsis after endoscopic surgery for upper urinary tract stones [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 611-615.
[9]	Xuecheng Wu, Yuanwei Li, Wuxiong Yuan, Jiansong Wang, Yongzhong Shi, Qiang Lu, Zhuo Li, Jia Chen, Zhe Liu, Yili Teng, Zhiyong Gao. Diagnostic value of inflammatory mediators profile combined with procalcitonin in urogenic sepsis [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 476-480.
[10]	Shangwen Dou, Huan Deng, Bangfeng Liu, Gaoyuanzhi Yue, Huacai Zhu, Yongda Liu. Role of preoperative urine culture re-examination in the prediction of infectious complications related to mini-percutaneous nephrolithotomy [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 361-366.
[11]	Ruanxin Miao, Xi Qiao. Role of Toll-like receptor in sepsis-induced acute kidney injury [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(04): 210-214.
[12]	Chao Gao, Jie Chao, Haibo Qiu. Emerging roles of transcription factor T-bet of Th17 in immune imbalance of sepsis [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 280-285.
[13]	Xiang Yang, Lanqi Guo, Jianfeng Xie, Haibo Qiu. Role of metagenomics next-generation sequencing in the pathogen diagnosis in sepsis [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 292-297.
[14]	Rui Tan, Jing Wang, Jiangquan Yu, Ruiqiang Zheng. Progress in understanding of role of high density lipoprotein, apolipoprotein A-I, and serum amyloid A in sepsis [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 749-753.
[15]	Xing Cai, Ruiqiang Zheng. Progress in application of heparin-binding protein in sepsis [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 487-490.

Please choose a citation manager

Content to export