SMFM Consult Series #47: Sepsis during pregnancy and the puerperium
SMFM Consult Series #47: Sepsis during pregnancy and the puerperium
复制标题
DOI：
10.1016/j.ajog.2019.01.216
复制
发表时间：
2019-04-01
影响因子：
9.8
通讯作者：
Louis, Judette M.
中科院分区：
文献类型：
--
作者：
Plante, Lauren A.;Pacheco, Luis D.;Louis, Judette M.
产妇败血症是产妇发病和死亡的一个重要原因，也是产妇死亡的一个可预防原因。本指南的目的是总结脓毒症的知识，并为妊娠期和产后脓毒症的管理提供指导。以下是SMFM的建议：（1）我们建议将脓毒症和脓毒性休克视为医疗紧急情况，并立即开始治疗和复苏（1B级）;（2）我们建议医疗服务提供者在存在感染过程的情况下，考虑诊断患有其他原因不明的终末器官损伤的妊娠患者的败血症，无论是否存在发烧（1B级）;（3）我们建议对任何疑似败血症的孕妇尽快给予经验性广谱抗生素，最好在1小时内（1B级）;（4）我们建议获得培养物（血液、尿液、呼吸道和其他指示）和血清乳酸水平，应尽快完成早期源代码控制（1C级）;（5）我们建议在脓毒症并发低血压或疑似器官灌注不足时早期给予1-2 L晶体溶液（1C级）;（6）我们建议在妊娠期和产后脓毒症伴持续性低血压和/或或尽管进行了液体复苏但仍存在灌注不足（1C级）;（7）我们建议仅因败血症指征而不立即分娩，分娩应根据产科指征决定（1B级）。
Maternal sepsis is a significant cause of maternal morbidity and mortality and is a preventable cause of maternal death. The purpose of this guideline is to summarize what is known about sepsis and to provide guidance for the management of sepsis in pregnancy and the postpartum period. The following are SMFM recommendations: (1) we recommend that sepsis and septic shock be considered medical emergencies and that treatment and resuscitation begin immediately (GRADE 1B); (2) we recommend that providers consider the diagnosis of sepsis in pregnant patients with otherwise unexplained end-organ damage in the presence of an infectious process, regardless of the presence of fever (GRADE 1B); (3) we recommend that empiric broad-spectrum antibiotics be administered as soon as possible, ideally within 1 hour, in any pregnant woman in whom sepsis is suspected (GRADE 1B); (4) we recommend obtaining cultures (blood, urine, respiratory, and others as indicated) and serum lactate levels in pregnant or postpartum women in whom sepsis is suspected or identified, and early source control should be completed as soon as possible (GRADE 1C); (5) we recommend early administration of 1-2 L of crystalloid solutions in sepsis complicated by hypotension or suspected organ hypoperfusion (GRADE 1C); (6) we recommend the use of norepinephrine as the first-line vasopressor during pregnancy and the postpartum period in sepsis with persistent hypotension and/or hypoperfusion despite fluid resuscitation (GRADE 1C); (7) we recommend against immediate delivery for the sole indication of sepsis and that delivery should be dictated by obstetric indications (GRADE 1B).