Abstract:
Abstract.
Introduction. Despite significant advances in diagnosis, medical management and antimicrobial therapy, sepsis in the puerperium remains an important
cause of maternal morbidity and mortality. The abnormalities associated with the clinical syndrome of
sepsis result from a nonspecific innate inflammatory
response. This is due to the fact that sepsis represents
a systemic inflammatory response syndrome (SIRS) to
infection or injury; therefore, it can rapidly progress to
septic shock and death despite aggressive treatment.
Severe sepsis with MODS has a mortality rate of 20–
40%, rising to around 60% if septicemic shock develops. Symptoms of sepsis may be less distinctive than
in the non-pregnant population and are not necessarily present in all cases; therefore, a high index of suspicion is necessary. The major pathogens causing sepsis
in the puerperium are: group A streptococcus (GAS),
also known as Streptococcus pyogenes, Escherichia
coli, Staphylococcus aureus, Streptococcus pneumonia,
methicillin-resistant S. aureus (MRSA), Clostridium
septicum, Morganella morganii and antibiotic-resistant Stenotrophomonas Moltrophilia. Multiple risk
factors for maternal sepsis have been identified: obesity, impaired glucose tolerance/diabetes, impaired
immunity/immunosuppressant medication, anemia,
vaginal discharge, history of pelvic infection, amniocentesis and other invasive procedures, cervical cerclage, prolonged spontaneous rupture of membranes,
caesarean section, wound hematomas, retained products of conception, GAS infection, vaginal trauma.
Material and methods. Presentation of case report using the following key-words: „infection”, „systemic inflammatory response syndrome (SIRS)”, „severe
sepsis”, „septic shock”, „multiorgan dysfunction syndrome (MODS)”.
Results. We present a case of perinatal infections
complicated with MODS.
Conclusions. The presence of pelvic hematomas
triggers the sepsis caused by multiple infections in
perinatal period and can significantly increase the
morbidity related to bleeding, infection, surgery and
blood product transfusion. The clinical situation may
worsen in the presence of pre-existing pathological
conditions before pregnancy.
