Analysis of 23 cases of maternal sepsis

doi:10.3877/cma.j.issn.2095-3259.2021.03.009

Abstract

Abstract:

Objective

To explore the clinical characteristics, diagnosis and treatment options of pregnancy-associated sepsis.

Methods

We retrospectively analyzed the clinical data of 23 patients with pregnancy-associated sepsis hospitalized in the Obstetrics department of Renmin Hospital of Wuhan University from January 2017 to December 2019, and analyzed the high-risk factors leading to sepsis in pregnant women, the distribution of pathogens of pregnancy-associated sepsis, treatment options and pregnancy outcomes.

Results

(1) The average age of the patients was 29.5 years. 12 cases were primiparous, and 11 cases were multiparous women. Sepsis occurred during pregnancy in 20 cases and puerperal period in three cases. (2) The main source of the infection in the 23 patients was genital tract. The most commonly used antibiotics were carbapenems (17 cases, 73.9%). (3) All of the 23 patients were cured and discharged. The average hospital stay was 9.5 days. (4) There were 21 live births and two stillbirth among the perinatal infants.The live births included 13 full-term births, and 8 preterm births.

Conclusions

Pregnancy-associated sepsis often occurred during pregnancy and reproductive tract infection was the main source of the infection, with Escherichia coli being the most common causative agent. Pregnancy associated sepsis is characterized by rapid onset and progression. Early identification of high-risk individuals and early administration of high-level antibiotics to combat the infection were critical to improve the pregnancy outcomes.

Key words: Sepsis, Pregnancy, Postpartum period, Puerperal infection

Liangyu Peng, Jianhua Chen, Jing Yang. Analysis of 23 cases of maternal sepsis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(03): 165-168.

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References 17

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病例	年龄(岁)	病因	白细胞(×10⁹/L)	乳酸(mmol/L)	体温(℃)	病原微生物	培养方式	qSOFA评分(分)				分娩方式	发病孕周	分娩孕周	新生儿体重(g)	妊娠并发症
病例	年龄(岁)	病因	白细胞(×10⁹/L)	乳酸(mmol/L)	体温(℃)	病原微生物	培养方式	总分	呼吸	收缩压	精神	分娩方式	发病孕周	分娩孕周	新生儿体重(g)	妊娠并发症
1	29	羊绒炎	17	0.6	39.0	大肠埃希菌	血	2	1	0	1	剖宫产	35⁺⁶	35⁺⁶	2200	早产
2	25	羊绒炎	21	1.1	39.0	金黄色葡萄球菌	血	3	1	1	1	剖宫产	37⁺³	37⁺³	3050	-
3	31	羊绒炎	19	1.0	39.0	大肠埃希菌	血	3	1	1	1	剖宫产	39⁺⁴	39⁺⁴	3500	-
4	38	羊绒炎	25	2.1	39.0	李斯特菌	白带	3	1	1	1	阴道产	32	32	-	死胎
5	28	羊绒炎	19	2.0	38.5	大肠埃希菌	血	2	1	1	0	剖宫产	30	30	1600	早产
6	31	羊绒炎	20	1.9	36.5	大肠埃希菌	血	2	1	1	0	剖宫产	34⁺⁴	34⁺⁴	2150	早产
7	25	羊绒炎	19	1.0	36.5	大肠埃希菌	血	3	1	1	1	剖宫产	36⁺¹	36⁺¹	2550	早产
8	43	羊绒炎	22	1.5	38.0	大肠埃希菌	血	2	0	1	1	阴道产	34⁺⁶	34⁺⁶	-	死胎
9	35	羊绒炎	19	1.7	39.6	大肠埃希菌	血	3	1	1	1	剖宫产	36⁺⁴	36⁺⁴	2580	早产
10	26	羊绒炎	18	1.9	37.8	大肠埃希菌	血	2	1	1	0	剖宫产	35	35⁺⁴	2150	早产
11	37	羊绒炎	25	1.0	38.5	大肠埃希菌	血	3	1	1	1	剖宫产	36⁺⁶	36⁺¹	2550	早产
12	26	羊绒炎	19	1.9	37.8	大肠埃希菌	血	2	1	1	0	剖宫产	38	38	2850	-
13	37	羊绒炎	18	1.0	38.5	大肠埃希菌	血	3	1	1	1	剖宫产	37	37	2550	-
14	29	肾积脓	28	2.0	38.5	大肠埃希菌	血	2	0	1	1	阴道产	产褥期	-	-	-
15	20	肾积水	18	1.8	39.0	大肠埃希菌	血	1	0	1	1	阴道产	21⁺²	37	3000	-
16	25	肾积水	16	1.1	37.8	大肠埃希菌	血	2	0	1	1	阴道产	39	39	3700	-
17	32	肾积水	21	1.5	39.0	大肠埃希菌	尿	2	0	1	1	剖宫产	产褥期	-	-	-
18	31	肾积水	17	0.6	38.5	大肠埃希菌	尿	2	0	1	1	阴道产	34⁺⁴	37⁺⁴	2800	-
19	27	肺炎	17	1.6	38.0	大肠埃希菌	血	3	1	1	1	剖宫产	37	37	3300	-
20	37	肺炎	21	1.9	40.0	大肠埃希菌	血	3	1	1	1	阴道产	25	39	2500	-
21	28	上呼吸道感染	19	1.0	40.0	肺炎克雷伯菌	血	3	1	1	1	剖宫产	37⁺¹	37⁺¹	3400	-
22	31	切口愈合不良	20	1.1	40.0	大肠埃希菌	血	3	1	1	1	剖宫产	产褥期	-	-	早产
23	31	阑尾炎	18	1.5	39.0	大肠埃希菌	血	2	0	1	1	阴道产	30⁺²	38	2750	-

病例	年龄(岁)	病因	白细胞(×10⁹/L)	乳酸(mmol/L)	体温(℃)	病原微生物	培养方式	qSOFA评分(分)				分娩方式	发病孕周	分娩孕周	新生儿体重(g)	妊娠并发症
病例	年龄(岁)	病因	白细胞(×10⁹/L)	乳酸(mmol/L)	体温(℃)	病原微生物	培养方式	总分	呼吸	收缩压	精神	分娩方式	发病孕周	分娩孕周	新生儿体重(g)	妊娠并发症
1	29	羊绒炎	17	0.6	39.0	大肠埃希菌	血	2	1	0	1	剖宫产	35⁺⁶	35⁺⁶	2200	早产
2	25	羊绒炎	21	1.1	39.0	金黄色葡萄球菌	血	3	1	1	1	剖宫产	37⁺³	37⁺³	3050	-
3	31	羊绒炎	19	1.0	39.0	大肠埃希菌	血	3	1	1	1	剖宫产	39⁺⁴	39⁺⁴	3500	-
4	38	羊绒炎	25	2.1	39.0	李斯特菌	白带	3	1	1	1	阴道产	32	32	-	死胎
5	28	羊绒炎	19	2.0	38.5	大肠埃希菌	血	2	1	1	0	剖宫产	30	30	1600	早产
6	31	羊绒炎	20	1.9	36.5	大肠埃希菌	血	2	1	1	0	剖宫产	34⁺⁴	34⁺⁴	2150	早产
7	25	羊绒炎	19	1.0	36.5	大肠埃希菌	血	3	1	1	1	剖宫产	36⁺¹	36⁺¹	2550	早产
8	43	羊绒炎	22	1.5	38.0	大肠埃希菌	血	2	0	1	1	阴道产	34⁺⁶	34⁺⁶	-	死胎
9	35	羊绒炎	19	1.7	39.6	大肠埃希菌	血	3	1	1	1	剖宫产	36⁺⁴	36⁺⁴	2580	早产
10	26	羊绒炎	18	1.9	37.8	大肠埃希菌	血	2	1	1	0	剖宫产	35	35⁺⁴	2150	早产
11	37	羊绒炎	25	1.0	38.5	大肠埃希菌	血	3	1	1	1	剖宫产	36⁺⁶	36⁺¹	2550	早产
12	26	羊绒炎	19	1.9	37.8	大肠埃希菌	血	2	1	1	0	剖宫产	38	38	2850	-
13	37	羊绒炎	18	1.0	38.5	大肠埃希菌	血	3	1	1	1	剖宫产	37	37	2550	-
14	29	肾积脓	28	2.0	38.5	大肠埃希菌	血	2	0	1	1	阴道产	产褥期	-	-	-
15	20	肾积水	18	1.8	39.0	大肠埃希菌	血	1	0	1	1	阴道产	21⁺²	37	3000	-
16	25	肾积水	16	1.1	37.8	大肠埃希菌	血	2	0	1	1	阴道产	39	39	3700	-
17	32	肾积水	21	1.5	39.0	大肠埃希菌	尿	2	0	1	1	剖宫产	产褥期	-	-	-
18	31	肾积水	17	0.6	38.5	大肠埃希菌	尿	2	0	1	1	阴道产	34⁺⁴	37⁺⁴	2800	-
19	27	肺炎	17	1.6	38.0	大肠埃希菌	血	3	1	1	1	剖宫产	37	37	3300	-
20	37	肺炎	21	1.9	40.0	大肠埃希菌	血	3	1	1	1	阴道产	25	39	2500	-
21	28	上呼吸道感染	19	1.0	40.0	肺炎克雷伯菌	血	3	1	1	1	剖宫产	37⁺¹	37⁺¹	3400	-
22	31	切口愈合不良	20	1.1	40.0	大肠埃希菌	血	3	1	1	1	剖宫产	产褥期	-	-	早产
23	31	阑尾炎	18	1.5	39.0	大肠埃希菌	血	2	0	1	1	阴道产	30⁺²	38	2750	-

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