Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Risk factors for, and the identifi cation and management of, genital tract sepsis
Successive Reports have identifi ed women who appear to be at increased risk of, or have predisposing
factors for, pelvic sepsis as shown in Box 7.5.
Box 7.5
Risk factors for maternal sepsis as identifi ed from the Confi dential Enquiries into Maternal Deaths
• Obesity
• Impaired glucose tolerance / diabetes
• Impaired immunity
• Anaemia
• Vaginal discharge
• History of pelvic infection
• History of Group B streptococcal infection
• Amniocentesis, and other invasive intrauterine procedures
• Cervical cerclage
• Prolonged SROM
• Vaginal trauma
• Caesarean section
• Wound haematoma
• Retained products of conception post miscarriage or post delivery.
Many of the women had one or more of these risk factors for sepsis, including cervical cerclage,
gestational diabetes, wound haematoma, retained products, and impaired immunity. Obesity is a risk factor
for infection and can also lead to practical diffi culties in managing care:
A woman collapsed and died due to a pulmonary embolism. She had several risk factors for this
including obesity, laparotomy for primary PPH, suboptimal thromboprophylaxis and vaginal sepsis due
to inadvertent retention of a tampon inserted during repair of vaginal tear. Vaginal examination was
extremely diffi cult because of her high BMI which was over 35. She had offensive lochia but the tampon
remained undiscovered despite several vaginal examinations until it was extruded a month later. This
case highlights some of the problems encountered in obese women and emphasises the importance of
accurate swab counts on all occasions.
Signs and symptoms
The signs and symptoms of genital tract sepsis are listed in Box 7.6. Most are non-specifi c and unless
genital tract sepsis is specifi cally considered in the differential diagnosis it may be missed until too late.
Severe sepsis with acute organ dysfunction has a 20-40% mortality rate. It can be insidious in onset and
patients often appear deceptively well until they suddenly deteriorate and collapse. If septicaemic shock
(sepsis with hypotension refractory to fl uid resuscitation) develops, the mortality rate rises to around 60%.
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