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close this bookClinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.)
close this folderCHAPTER 6 - MANAGEMENT OF SEPSIS
View the document6.1 INTRODUCTION
View the document6.2 PRESENTATION
View the document6.3 ASSESSMENT OF SEVERITY OF INFECTION AND SEPSIS
View the document6.4 INITIAL TREATMENT
View the document6.5 DEFINITIVE MANAGEMENT
View the document6.6 CONTINUING TREATMENT

6.4 INITIAL TREATMENT

Immediate treatment with antibiotics is a life-saving measure for ANY woman with a pelvic infection and at ANY risk for sepsis.

Universal Measures

Make sure the airway is open. Closely monitor the woman's vital signs and general condition, keeping in mind that her condition could suddenly change. Adjust treatment if she becomes unstable, following the guidelines for the treatment of shock. Do NOT give fluids by mouth to a woman in shock, at high risk for shock, or with an intra-abdominal injury, as she can vomit and inhale the vomit or she may require surgery.

· If the woman is at high risk for shock, IMMEDIATELY begin IV antibiotics, and follow the treatment guidelines in Chapter 2.

· If the woman is at low risk for shock, immediately begin antibiotics and follow the treatment guidelines below.

Oxygen

Make sure that the airway is open. Oxygen is NOT necessary if the woman is stable and is at low risk for shock. If she becomes unstable and oxygen is available, then start oxygen at 6-8 litres a minute by mask or nasal cannulae.

Fluids

If available, start an IV for every woman with ANY risk for sepsis, and start IV antibiotics immediately. Intravenous administration is the quickest and best way of treating an infection and may well save the woman's life. If the woman becomes or is unstable, follow the fluid guidelines for the treatment of shock in Chapter 2.

Medicines11

11 Corticosteroids: The use of high-dose corticosteroids as adjunctive therapy is contra-indicated.

Inotropic drugs: Inotropic drugs such as digoxin should be used in shock only when hypovolaemia has been excluded confidently.

For women at high risk or in shock: IV or IM ONLY (IV preferred). Do NOT give any medicines by mouth to a woman in shock.

For women at low risk for septic shock: IV preferred. If IV not available, IM or oral acceptable.

Antibiotics. IV preferred. Start antibiotics immediately. Give broad spectrum antibiotics which are effective against Gram-negative, Gram-positive, anaerobic organisms and chlamydia. For the choice of antibiotics, see Chapter 7.

Tetanus Toxoid. IM. If there is a possibility that the woman was exposed to tetanus, and there is any uncertainty of her vaccination history, then give her tetanus toxoid and tetanus antitoxin. If the abortion was not performed with sterile instruments, if there was any contamination of the instruments or wound with din, there is a chance of exposure to tetanus. See Chapter 7.

Pain control. Give as needed, follow guidelines above and in Chapter 7.

Labs

While lab work is helpful in treatment, the treatment of sepsis should begin without delay even where lab work is not possible.

Blood. If the woman has lost a lot of blood or appears anaemic, check haemoglobin or haematocrit and collect blood for type and cross-match. If available, a complete blood count (CBC) can also serve as a measure of infection (high number of white blood cells) and a measure of the bleeding disorder DIC that may be seen with severe cases of sepsis. If DIC is present, there will be a low number of platelets.

Urine. Little or no urine output is a sign of low blood volume seen with shock, haemorrhage, and dehydration, and can be a sign of kidney failure. Measure urine output, preferably by insertion of a Foley catheter. If catheterization is not possible, collect and measure urine output. If it is not possible to collect the urine, note if the urine is concentrated (dark colour) or if the output is decreased (no urination). If output is first low and then begins to increase, this is a sign that the woman's general condition is improving and a measure of her response to intravenous fluids.

Abdominal X-Rays. Flat-plate and upright films may be taken. See discussion on x-rays below.

Additional Measures

X-Rays. For women at high risk, x-ray the abdomen (if possible) to assess the extent and severity of the infection. Flat-plate abdominal x-ray films are taken to identify air or fluid levels in the bowel. In the case of clostridial infection, gas may be seen in the tissues. The presence of an IUD may also be confirmed. Upright abdominal x-ray films will show air under the diaphragm from uterine or bowel perforation.