Sepsis is a “cunning, insidious and non-specific illness” (Raynor, 2012) but progression can be rapturous with a sudden catastrophic circulatory collapse and mortality up to 50%. (Angus et al., 2001) Over five million cases arise per year of maternal sepsis, resulting in an estimated 62,000 maternal deaths globally (WHO, 2008) During the 18th and 19th century, puerperal sepsis resulted in 50% of maternal deaths over Europe (Loudon, 2000). The World Health Organisation (WHO) defined puerperal sepsis as ‘infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum, of which two or more of the following are present: pelvic pain, fever 38.5C or more, abnormal vaginal discharge, abnormal smell of discharge, and delay in the rate of reduction of size of uterus (less than 2 cm a day during the first 8 days)’ (WHO, 1992).
“ Sepsis” according to the International Surviving Sepsis Campaign, is defined as the presence of infection together with systemic manifestations of infection (Dellinger et al., 2013) In todays modern society sepsis still accounts for 15% of maternal deaths a year worldwide (Dolea & Stein, 2003). Despite medical advances, aseptic technique, and antibiotic use, sepsis is the most common cause of direct maternal death in the UK. According to the CMACE report the maternal mortality rate increased from 0.85 deaths per 100,000 maternities in 2003–05 to 1.13 deaths in 2006–08 (Harper, 2011). Puerperal sepsis has a long history within obstetrics and midwifery, and yet despite this knowledge it has become, yet again, the leading cause of direct maternal death. Therefore due to the increased maternal mortality, I have chosen to focus on the care of a woman within ...
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... family members on the dangers of GAS and other microbial infection during and after pregnancy.
Conclusion
In this case, the onset of sepsis was detected speedily with the Midwife acting on her instincts thus promptly informing key members of the multidisciplinary team. Sepsis may be insidious in onset however it may also rapidly progress misleading health care workers of its severity, which is evident in the latest CMACE report. Returning “back to the basics” is key in the early detection and treatment of sepsis and is an essential factor to decreasing the direct cause of maternal mortality hence midwives must remain vigilant to signs and symptoms of infection. There is clearly a need to raise both maternal and professional awareness about sepsis so that it can be prevented, where possible, and finally lead to a decrease in the direct cause of maternal death.
However with septic shock the symptoms may be worse as the patient may experience tachyeordia and tachypnae, leucocytosis which is a high count of white blood cells, change in metal state for example confusion and hyperglycaemia which is a deficiency of glucose in the bloodstream. The diagnosis for sepsis and septic shock involve using blood cultures which is where bacteria is detected in blood which may have spread from a different part of the body. Blood cultures are taken mostly to be done on new-borns and young children who have the symptoms of sepsis. If the blood culture tests positive there is a bacterial or fungal infection which needs to be treated immediately as it is life-threatening. Also cytokines are used as they can destroy the infection however there is a problem with this diagnosis as excessive production can cause tissue and organ
Unfortunately, infection places people in the hospital and infection is developed in the hospital. Two ways to contract sepsis are through hospital-caused infection, like in Amy Widener’s case, and through an infection caused by outside sources, for example a urinary tract infection in an elderly person. Everyone is capable of getting sepsis however cases appear most often in children under one year of age and in elderly older than sixty-five years. This is due to the body’s immune system being weaker in these demographics than in a person that has a built-up and strong immune system (“Sepsis Questions and Answers”). Sepsis occurs because of infection so the immune system plays a large role in the body’s defense mechanism. When people with already compromised immune systems develop an infection or are in an environment that infection is likely to occur, for example an unsanitary procedure in a hospital, then the body’s chances of being able to fight the infection off are greatly
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
These women could anticipate delays in normal growth and development for the fetus. The exact cause of post term pregnancy is unknown. The mother experiencing post term pregnancy is at risk for trauma, hemorrhage, infection, and labor abnormalities (Ward et al., 2016, p. 543). Labor induction prior to 42 weeks’ gestation prevents MAS and other complications. A biophysical profile measuring the heart rate, breathing and body movements, tone, and the amniotic fluid volume is used to monitor the fetus for intrapartum fetal stress that could cause passage of meconium. Diabetic woman is at high risk for preeclampsia or eclampsia, infection, hydramnios, postpartum hemorrhage, and cesarean birth (Ward et al., 2016, p. 383). In addition, fetal macrosomia prolongs labor due to shoulder dystocia. The glucose challenge test, and the 3- hour OGTT is used for gestational diabetes screening, done after 24 weeks of pregnancy. Abnormalities of the respiratory system as explained earlier are the most concerning complication of MAS, needing immediate
Urinary Tract Infection, also known as UTI, occurs in two common locations, the bladder and kidneys. The kidneys are important organs that aid in filtering out waste products from blood and maintaining water distribution throughout the body. The waste products are filtered out via bladder, which is the reason of the bladder being the second site for the infection. A normal human being has two kidneys, one on left and right side, a bean shaped organ, and is located at the back of the abdomen. “Each kidney is about 11.5 cm long, 5-7.5 cm broad, 5 cm thick, and weight about 150 grams” (HealthInfoNet, Paragraph 2). Furthermore, a bacterium named Escherichia coli lives in both the kidneys and the GI tract. E. coli is part of the human body and produces
Many great historical figures of the scientific community have written on the subject of the same perplexing disease over the centuries (Angus, van der Poll, Finfer, Vincent 2013). Sepsis has been given many names, origins, and etiologies. In the 4th century, Hippocrates declared the disease the cause of organic decomposition, wound festering, and swamp gas (Angus et al. 2013). During the 19th century, Louis Pasteur theorized the disease was the outcome of a pathogenic microorganism in the bloodstream, which resulted in a body-wide infection (Angus et al. 2013). In the 21st century, the medical community made a breakthrough with the discovery of the disease’s link to the inflammatory response system and devised a plan of action to combat the high mortality rates among those infected (Angus et al. 2013). According to Hotchkiss, Monneret, & Payen (2013) the effects of sepsis are well documented, while the molecular processes it utilizes are still being explored; however, new studies are helping to expand our understanding of the centuries old disease.
According to Steen and Marchant (2007), 60-70% of women will require sutures after vaginal delivery. A common morbidity of lacerations in the perineum is acute pain (Steen et al., 2007). Indeed, many women who have had birth related lacerations have decreased mobility, difficulty sitting comfortably, or fear of defecation due to pain (Steen et al. 2007). Furthermore, this pain may impede a mother from breastfeeding, focusing on newborn care and can lead to increasing irritability (Steen et al., 2007).
Bacterial vaginosis is identified with patient with high incidence of endometritis and pelvic inflammatory disease status post abortion and/or gynecological procedures (Hainer & Gibson, 2011). This vaginal infection, bacterial vaginosis, has been associated with status post and postpartum endometritis, pelvic inflammatory disease (PID), and during pregnancy, late fetal loss and spontaneous preterm birth (Verstraelen, Verhelst, Vaneechoutte, & Temmerman, 2010).
In my previous role as a Licensed vocational nurse, I worked in the outpatient setting, Perinatology, where there are high-risk pregnant patients. The patient I helped take care of, was early in her pregnancy, approximately 29 weeks, and was a patient who had been seen in this clinical office
E. Coli 0157, written by Mary Heersink, is a nerve-racking, adrenaline-filled story of a mother's experience with a then unknown deadly bacteria. The book brings up many reactions in its readers, especially the questioning of the practice of doctors in hospitals. The reader's knowledge base of scientific procedures in emergency centers was widened as well as the knowledge of how to the human body reacts to different agents in its system.
For the purpose of this assignment, a case study has been selected in order to relate the signs and symptoms of sepsis to the underlying pathophysiology of the sepsis continuum. In order to maintain patient confidentiality, names dates and times have been changed or omitted, in line with Australian Nursing and Midwifery Code of Professional Conduct (ANMCC, 2008).
Worldwide, the rate of cesarean section is increasing. According to the CDC, in 2012 the rate of cesarean sections comprised 32.8% of all births in the United States (CDC, 2013). Between 1996-2009 the cesarean section rate has risen 60% in the U.S (CDC, 2013). According to the World Health Organization (WHO), more than 50% of the 137 countries studies had cesarean section rates higher than 15% (WHO, 2010). The current goal of U.S. 2020 Healthy People is to reduce the rate of cesarean section to a target of 23.9%, which is almost 10% lower than the current rate (Healthy People 2020, 2013). According to a study conducted by Gonzales, Tapia, Fort, and Betran (2013), the appropriate percentage of performed cesarean sections is unclear, and is dependent on the circumstances of each individual birth (p. 643). Though often a life-saving procedure when necessary, the risks and complications associated with cesarean delivery are a cause for alarm due to the documented rate increase of this procedure across the globe. Many studies have revealed that cesarean deliveries increase the incidence of maternal hemorrhage and mortality and neonatal respiratory distress when compared to vaginal deliveries. As a result, current research suggests that efforts to reduce the rate of non-medically indicated cesarean sections should be made, and that comprehensive patient education should be provided when considering an elective cesarean delivery over a planned vaginal delivery.
During the time period abortions were illegalized, it’s estimated that thousands of women died or suffered serious debilitating medical problems after attempting to self-induce their abortions or going to untrained practitioners through back-alley abortions who used primitive methods as well as unsanitary conditions. Once an abortion attempt was made, the hospital had to treat these women. However many of them were treated with distain. Some women are not fit to be mothers and some were just unprepared. Whatever the reason it’s the woman’s concern.
Bacterial vaginosis is one of the major contributors of vaginal infections during pregnancy and accounts for 40 percent of these cases. Generally, bacterial vaginosis is associated with several obstretic complications like pre-term labor and delivery, untimely rupture of membranes, postpartum endometrisis, and chorioamnionitis (Wang et. al., 2010, p.444). Metronidazole has traditionally been used as the drug of choice in the treatment of bacterial vaginosis because it is an agent of the nitroimidazole antibiotic family. This drug has been used for several decades because it efficiency in treating the condition ranges between 80 and 90 percent and can be administered across all pregnancy stages while tolerated by pregnant women. The ability of the drug to achieve the high levels of efficacy is attributed to the fact that it can be found in the cord blood, fetal tissue, and amniotic fluid in high concentrations.
Jancárková, N., & Gregor, V. (2000). [Teratogens during pregnancy]. Ceska gynekologie/Ceska lekarska spolecnost J. Ev. Purkyne, 65(3), 188-194.