Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes.
OBJECTIVE
To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock.


METHODS
We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher's Exact and Mann-Whitney U tests.


RESULTS
Pyelonephritis was the most common etiology overall (37%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50%) and septic shock (80%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p ≤ 0.001), total bilirubin >4 mg/dl (p = 0.04), failure in ≥3 organ systems (70% vs. 15%, p = 0.005), and maternal death (30% vs. 0%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40% with severe sepsis. 71% of viable pregnancies required emergent cesarean delivery, and 50% of these for worsening respiratory function.


CONCLUSIONS
ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery.
Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinanati, Ohio 45267-0526, USA. snyder.candice@gmail.com
Candice C
CC
Snyder
John R
JR
Barton
Mounira
M
Habli
Baha M
BM
Sibai
D000328:Adult; D001663:Bilirubin / Q000097:blood; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods*; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D063130:Maternal Death / Q000706:statistics & numerical data; D009102:Multiple Organ Failure / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D011256:Pregnancy Outcome; D011704:Pyelonephritis / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012772:Shock, Septic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
D001663:Bilirubin