Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.): CHAPTER 6 - MANAGEMENT OF SEPSIS: 6.3 ASSESSMENT OF SEVERITY OF INFECTION AND SEPSIS

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Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.)

CHAPTER 6 - MANAGEMENT OF SEPSIS

		6.1 INTRODUCTION
		6.2 PRESENTATION
		6.3 ASSESSMENT OF SEVERITY OF INFECTION AND SEPSIS
		6.4 INITIAL TREATMENT
		6.5 DEFINITIVE MANAGEMENT
		6.6 CONTINUING TREATMENT

6.3 ASSESSMENT OF SEVERITY OF INFECTION AND SEPSIS

When a patient has signs and symptoms of infection, quickly assess the severity of the infection and the risk for septic shock. The following may be seen with pelvic infection:

· foreign material in the vagina
· pus coming from cervix or mixed with blood in the vagina
· signs of local pelvic infection: uterine tenderness, tenderness when the cervix is moved, lower abdominal tenderness, or adnexal tenderness (near ovaries and tubes)
· foul odour to any blood or secretions
· uterine subinvolution.

Assess the woman's risk for developing septic shock using the following guidelines:

Table 7 Risk for Septic Shock
LOW RISK	HIGH RISK
first trimester abortion	second trimester abortion
mild to moderate fever (36.5-38.5°C or 99.5-101.5°F)	high fever (38.5°C or 101.5°F and greater) or subnormal temperature
no evidence of intra-abdominal injury	ANY evidence of intra-abdominal injury: distended abdomen, decreased bowel sounds, rigid abdomen, rebound tenderness, nausea and vomiting
stable vital signs	ANY evidence of shock: low blood pressure (systolic less than 90 mmHg), anxiety, confusion, unconsciousness pallor (inner eyelids, around the mouth, palms), rapid, weak pulse (rate 110 per minute or more), rapid breathing (respirations 30 per minute or greater)