Acute hypotension related to sepsis in the obstetric patient

While infections are a common complication of pregnancy, bacteremia and septic shock are relatively rare. Efforts to prevent serious bacterial infections are the most effective means of minimizing maternal and fetal morbidity. Screening for first trimester asymptomatic bacteriuria, prompt and thorough evaluation of suspected bacterial infections, and conscientious intrapartum assessment can have a significant impact in decreasing localized bacterial infections. The prompt recognition and institution of antimicrobial therapy in women suspected of having systemic infections is of paramount importance in reducing the incidence of serious maternal morbidity and mortality. Initial efforts in the treatment of sepsis should be directed at intravascular volume expansion in an effort to improve myocardial performance and tissue oxygenation. Inotropic agents occasionally may be necessary; however, they should be used with caution and only after adequate volume expansion has been provided. Adequate antimicrobial therapy requires treatment with multiagent therapy, providing coverage for the wide variety of genital tract pathogens.