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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty-eight deaths during pregnancy, parturition and puerperium were recorded in Sweden during the years 1971-80, giving a maternal mortality of 6.6 per 100,000 live births. The figures for abdominal delivery and vaginal were 45.0 and 2.5 per 100,000 live births respectively. Amniotic fluid embolism, pulmonary embolism and hemorrhage were the main causes of death within 24 hours after delivery, while pre-eclampsia/eclampsia and sepsis were predominant during the rest of the puerperium. Age and parity are highly important risk factors. Presumed avoidable factors were identified in 19% of the cases. 9% of the deaths were related to unwanted pregnancy.
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PMID:Maternal deaths in Sweden, 1971-1980. 372 41

The causes of non-haemorrhagic obstetric shock (pulmonary thromboembolism, amniotic fluid embolism, acute uterine inversion and sepsis) are uncommon but responsible for the majority of maternal deaths in the developed world. Clinically suspected pulmonary thromboembolism should be treated initially with heparin and objective testing should be performed. If the diagnosis is confirmed, heparin is usually continued until delivery, following which anticoagulation in the puerperium is achieved with either warfarin or heparin. Amniotic fluid embolism is a rare complication of pregnancy, occurring most commonly during labour. The management of amniotic fluid embolism involves maternal oxygenation, the maintenance of cardiac output and blood pressure, and the management of any associated coagulopathy. Acute uterine inversion arises most commonly following mismanagement of the third stage of labour. The shock in uterine inversion is neurogenic in origin, although there may also be profound haemorrhage. The management of this condition includes maternal resuscitation and replacement of the uterus either manually, surgically or by hydrostatic pressure. Genital tract sepsis remains a significant cause of maternal death, the most common predisposing factor being prolonged rupture of the fetal membranes. The management of septic shock in pregnancy includes resuscitation, identification of the source of infection and alteration of the systemic inflammatory response.
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PMID:Non-haemorrhagic obstetric shock. 1078 58

Introduction In recent years, several reports have appeared in the international literature concerning evolution and prognosis for obstetric patients whose illnesses have led to admission to intensive care units (ICUs). The term severe maternal morbidity has been proposed to refer to life-threatening complications that occur during pregnancy, delivery or postpartum. Objective Characterize severe maternal morbidity in obstetric patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana from 1998 to 2004. Methods From 1998 to 2004, we conducted a prospective, descriptive, and observational study of 312 patients admitted to the ICU of the Enrique Cabrera General Teaching Hospital in Havana, Cuba. Patients were included whose length of stay was >24 hours, and whose family members provided written informed consent. A data collection form was developed to record general characteristics, personal and family medical history, cause of ICU admission, diagnosis, obstetric condition at the onset of illness and at admission, pregnancy outcome, surgeries performed and patient's ICU discharge status (survivor or non-survivor), the latter a dependent variable. An Excel database was compiled and processed using SPSS 13.0. Percentages were used to summarize qualitative variables. A Chi-square test was used for univariate analysis between these qualitative variables and patient discharge status; t-test was used for quantitative analyses. Results Overall mortality in the cohort was 7.4% (23 patients), greater among women aged <20 years, those with a history of previous illnesses, and those subjected to several surgical interventions. Obstetric hemorrhage, pre-eclampsia/eclampsia, and postpartum sepsis were the most commonly diagnosed obstetric disorders. Non-obstetric disorders diagnosed included severe asthma, pneumonia and peritonitis. Amniotic fluid embolism, postpartum sepsis, early postpartum hemorrhage and pre-eclampsia/eclampsia were associated with the highest hospital case fatality rates in women with obstetric disorders; while acute chest syndrome, promyelocytic leukemia and pulmonary embolism were associated with the highest hospital case fatality rates among women with non-obstetric disorders. Conclusions Our results concur with most of those published on severe maternal morbidity in ICUs, including a high incidence of hemorrhagic disorders, pre-eclampsia and postpartum sepsis. The number of patients with hematological disorders accounts for the difference between the results of our study and others concerning morbidity and mortality among this patient group. A significant correlation was observed between history of previous illnesses and patient discharge status. Prognosis was worse for patients subjected to several surgical interventions, which can be attributed to the higher risk of complications and the severity of the underlying illness.
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PMID:Severe maternal morbidity in the intensive care unit of a havana teaching hospital,1998 to 2004. 2148 65