Sepsis Bundle Approach in Early Recognition and Timely Management of Sepsis in Obstetric Patients

Objective: To study the maternal outcome using “sepsis bundle approach” in obstetric patient with sepsis or septicshock.Methods: The present study was an observational study on patients presenting with features of sepsis admitted inhospital for management, fulfilling the inclusion and exclusion criteria. A thorough history and physicalexamination were done. Investigation including serum lactate and blood culture was done. Patients were managedas per the guidelines of sepsis bundle approach and outcome noted in terms of, application of sepsis bundleapproach and outcome, blood culture positivity and organism involved, high serum lactate and mortality, durationof ICU stay.Results: Majority of women with sepsis were post-partum females (53%) belonged to age range of 20 to 24 years(64.7%) and were of lower middle class. Obstetric causes of sepsis were documented in 40 out of 51 cases. Amongthem, most common diagnosis associated with sepsis was Purpureal pyrexia. Most of the blood culture came outto be sterile (39.2%) and most common organism observed in blood culture was E.coli (31.3%), followed byKlebsiella. About 29 cases (55.9%) cases required fluid resuscitation in addition to broad spectrum antibiotics,of them, 27 patients recovered and mortality was documented in 2 cases. Maternal mortality due to underlyingsepsis was documented in 11.8% cases. Serum lactate and WBC count were raised in 83.3% and 100% casesrespectively. The observed association of mortality with comorbidities was statistically significant (p<0.05).Conclusion: Obstetric sepsis and septic shock during pregnancy and postpartum period is one of the majorcontributors of maternal mortality. Using a standardized protocol can help in early identification of sepsis andimmediate management can significantly improve maternal outcome, and help in reducing maternal mortalityassociated with sepsis.