Managing Medical and Obstetric Emergencies and Trauma. Группа авторов

– titrate supplemental oxygen to keep SaO2 >94%

       Thromboprophylaxis – prophylactic LMWH dose by weight for at least 10 days

       Corticosteroids – if oxygen dependent give for a total of 10 days or until discharge (oral prednisolone 40 mg OD or IV, hydrocortisone 80 mg BD)

       If steroids are required for fetal lung maturation use dexamethasone 12 mg IM for two doses followed by either of the above corticosteroids for 10 days

       Give tociluzimab (or sarilumab if unavailable) if hypoxic (oxygen requirement) and C‐reactive protein >75

       If SARS‐CoV‐2 antibody negative and non‐Omicron variant (anti‐spike protein testing), consider 2.4 g Ronapreve® IV

       Chest imaging is essential for evaluation of the unwell pregnant woman with Covid‐19 and should be performed if indicated

       Careful fluid balance

      Clinical deterioration (increasing oxygen requirements, SaO₂ <93%, respiratory rate >22):

       Convene the MDT to consider the site and location of care, including an obstetrician, anaesthetist, neonatologist, intensivist and infectious disease physician

       Consider admission to critical care for respiratory support (invasive or non‐invasive), proning and early discussion with ECMO centre

7.7 Summary

       Physiological and immune changes in pregnancy can increase the severity of some infections

       Awareness is need to recognise sepsis which can present with non‐specific symptoms and signs

       Do not rely on temperature (either high or low)

       Altered mental state is a medical emergency

       Antibiotics, fluid resuscitation and senior review must all happen within 1 hour

       Puerperal sepsis can be insidious in onset and can progress rapidly to fulminating sepsis and death

       Think sepsis; act quickly; assess and reassess; senior review; expert advice

7.8 Further reading

      1 Acosta CD, Kurinczuk JJ, Lucas DN, Tuffnell DJ, Sellars S, Knight M ; United Kingdom Obstetric Surveillance System. Severe maternal sepsis in the UK, 2011–2012: a national case–control study. PLoS Med 2014; 11(7): e1001672.

      2 Bonet M, Pileggi VN, Rijken MJ, et al. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation. Reprod Health 2017; 14(1): 67.

      3 Knight M, Bunch K, Tuffnell D, et al (eds) on behalf of MBRRACE‐UK. Saving Lives, Improving Mothers’ Care – Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015–17 . Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2019.

      4 Knowles SJ, O’Sullivan NP, Meenan AM, Hanniffy R, Robson M . Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG 2015; 122 (5): 663–71.

      5 Kourtis AP, Read JS, Jamieson DJ . Pregnancy and infection. N Engl J Med 2014; 370: 2211–18.

      6 NICE (National Institute for Health and Care Excellence). Sepsis: Recognition, Diagnosis and Early Management. NG51. London: NICE, 2016.

      7 Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis‐3). JAMA 2016; 315(8): 801–10.

      8 Surviving Sepsis campaign: http://www.survivingsepsis.org (last accessed January 2022).

      9 Turner MJ . Maternal sepsis is an evolving challenge. Int J Gynecol Obstet 2019: 146: 39–42.

Appendix 7.1 Viral rash in pregnancy

      Information on the investigation, diagnosis and management of a pregnant woman who has, or is exposed to, viral rash illness (including Zika virus) can be found at https://www.gov.uk/government/publications/viral‐rash‐in‐pregnancy (updated in July 2019; last accessed January 2022).