Management of severe sepsis and septic shock in pregnancy to improve the survival

Background: Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Early recognition and timely treatment is the key to ensuring a favorable outcome. Aim: To know the prevalence of maternal severe sepsis and septic shock and calculate the case fatality rate and to apply the principles of management suggested by surviving sepsis guidelines in improving the survival. Materials and methods: This prospective study was carried out in the labour room, department of obstetrics and gynaecology, King George hospital, Andhra medical college for a period of six months from December 2016 to May 2017. All the women who had the criteria satisfied were included in the study. They were all diagnosed and managed as per the recommendations given by surviving sepsis guidelines published in 2016. Results: Incidence of maternal severe sepsis and septic shock was 0.36% of all admissions to labour room. Out of 0.36% there were three deaths giving case fatality rate of 20%. Deaths due to severe sepsis and septic shock accounted for 20% of all maternal deaths in our institute. Literature gives a mortality rate of 20 to 40% for severe sepsis with acute organ dysfunction, which increases to 60% if septic shock develops. Conclusion: Awareness of the diagnosis of maternal sepsis and management as per the guidelines suggested by the surviving sepsis guidelines is crucial for improving the outcome.