Infections in Pregnancy: Septic Shock

Septic shock occurs because of severe sepsis. Sepsis, also called “blood poisoning,” refers to complications caused by the initial blood infection. Septic shock is the severe aftermath of uncontrolled sepsis. Both have similar symptoms, such as severely low blood pressure. However, sepsis can cause changes in your mental state (shock) and widespread organ damage.

Septic shock causes a variety of systemic signs and symptoms, including:

• restlessness and disorientation
• rapid heart rate and low blood pressure (hypotension)
• fever of 103˚F or higher
• low body temperature (hypothermia)
• skin that’s warm and flushed due to dilation of your blood vessels (vasodilation)
• cool and clammy skin
• irregular heart beat
• yellowing of your skin (jaundice)
• decreased urination
• spontaneous bleeding from your genital or urinary tract

You may also experience symptoms related to the primary site of infection. In pregnant women, these symptoms will often include:

• discolored uterine discharge
• uterine tenderness
• pain and tenderness in your abdomen and flank (the area between the ribs and hip)

Another common complication is adult respiratory distress syndrome (ARDS). Symptoms include:

• shortness of breath
• rapid and labored breathing
• coughing
• lung congestion

ARDS is one of the major causes of death in cases of severe sepsis.

The most common bacteria responsible for sepsis are aerobic gram-negative bacilli (rod-shaped bacteria), principally:

• Escherichia coli (E. coli)
• Klebsiella pneumoniae
• Proteus species

These bacteria have double membranes, which make them more resistant to antibiotics.

When they enter your bloodstream, they can cause damage to your vital organs.

In pregnant women, septic shock may be caused by:

• infections during labor and delivery
• cesarean sections
• pneumonia
• weakened immune system
• influenza (the flu)
• abortions
• miscarriage

The symptoms associated with septic shock are very similar to symptoms of other very serious conditions. Your doctor will conduct a thorough physical examination, and they will likely order laboratory tests.

Your doctor may use blood tests to look for:

• evidence of infection
• problems with blood clotting
• liver or kidney problems
• electrolyte imbalances

Your doctor may order a chest x-ray to find out if you have ARDS or pneumonia. CT scans, MRIs, and ultrasounds may help identify the primary infection site. You may also need electrocardiographic monitoring to detect irregular heart rhythms and signs of injury to your heart.

There are three major goals in the treatment of septic shock.

Blood Circulation

Your doctor’s first objective is to correct problems with your blood circulation. They may use a large intravenous catheter to give you fluids. They’ll monitor your pulse, blood pressure, and urine output to make sure you receive the proper amounts of these fluids.

Your doctor may insert a right heart catheter as another monitoring device if the initial fluid infusion doesn’t restore proper blood circulation. You may also receive dopamine. This drug improves the function of the heart and increases blood flow to major organs.

Antibiotics

The second objective of treatment is to give you antibiotics targeted against the most likely bacteria. For genital tract infections, a highly effective treatment is the combination of:

• penicillin (PenVK) or ampicillin (Principen), plus
• clindamycin (Cleocin) or metronidazole (Flagyl), plus
• gentamicin (Garamycin) or aztreonam (Azactam).

Alternatively, imipenem-cilastatin (Primaxin) or meropenem (Merrem) can be given as single drugs.

Supportive Care

The third major objective of treatment is to provide supportive care. Medications that reduce fever and a cooling blanket will help keep your temperature as close to normal as possible. Your doctor should quickly identify issues with blood clotting and begin treatment with an infusion of blood platelets and coagulation factors.

Finally, your doctor will give you supplemental oxygen and observe you closely for evidence of ARDS. Your oxygen status will be closely monitored with either a pulse oximeter or a radial artery catheter. If respiratory failure becomes evident, you’ll be put on an oxygen support system.

Surgical Treatments

You may also require surgery. Surgical treatments could be used to drain pus collected in your pelvis, or to remove infected pelvic organs.

If you have a suppressed immune system, you may be prescribed an infusion of white blood cells. Another option is an antisera (anti-toxin) therapy targeted against the usual bacteria that cause septic shock. This therapy has appeared promising in some investigations, but remains experimental.

Septic shock is a serious infection, but it’s important to realize that it’s a rare condition in pregnancy. In fact, the Obstetrics and Gynecologyjournal estimates that up to 0.01 percent of all deliveries cause septic shock. Women who have adequate pregnancy care are less likely to develop sepsis and resulting shock. If you experience any unusual symptoms, it’s important to call your doctor right away to prevent any widespread damage.