Blood Infection (Sepsis) During Pregnancy

Sepsis is a medical complication associated with an underlying infection that spreads to the entire bloodstream. It can occur during pregnancy as well and must be detected and treated early to avoid any complications.

What Is Sepsis?

In common words, sepsis is blood poisoning or an infection of the blood. It is caused by the body’s response to an infection in body parts like the lungs, urinary tract, bladder, kidney, stomach etc. When the bacteria enter the bloodstream, it is called sepsis.

In medical terms, the body releases certain chemicals in the blood to fight any infection. When the body’s immunological system malfunctions, these chemicals trigger widespread inflammatory conditions throughout the body and sepsis occurs. It affects all other body organs and the entire bloodstream because it causes disruption in the supply of blood to various vital organs.

In its extreme form, it can cause septic shock, a condition in which the blood pressure falls to dangerous levels. This, in turn, can lead to multiple organ failure and death.

Infection in blood during pregnancy is called maternal sepsis. One-third of pregnant women all over the world suffer from maternal sepsis. It can lead to serious complications if left undiagnosed and not treated in time.

There are also chances that about 15-30% of the sepsis-causing pathogen will pass onto the baby during delivery and the baby will be born with the infection as well. That is why sepsis and pregnancy is a topic that pregnant women and their family should be well aware of.

However, the incidence of death due to sepsis in pregnant women is much lesser (compared to the general sepsis patients) due to their younger age.

What Causes Blood Infection in Pregnancy?

There has also been an overall rise in the number of sepsis cases these days because of higher life expectancy, more invasive medical interventions, growing immunological disorders and resistance to pathogens, etc. There has been an increase in sepsis during pregnancy as well. Here are a few causes of sepsis in pregnancy:

1. Age of conception: Many women conceiving are over 40 years old and/or they have other underlying health issues like type 2 diabetes, obesity, and hypertension.
2. Artificial insemination: New technologies aiding insemination and new medicines for the foetus is also associated with Sepsis.
3. Abortions: Abortions, when not performed with care, especially if the patient has low immunity is low etc., can cause infections and even sepsis. If you notice symptoms like fatigue, vaginal discharge, recurring fever, cough, etc. after an abortion, please consult your doctor.
4. Long delivery: The delivery has been long, complicated, induced or via cesarean, there are higher chances of developing sepsis.
5. Other illness: If you have other acute illness/infection during pregnancy and you show signs of associated complications, then you are prone to sepsis.

Signs and Symptoms of Maternal Sepsis

Sepsis spreads very fast during pregnancy. There may be no prolonged symptoms and suddenly the expecting woman may fall sick. It is important to understand and watch out for the signs and symptoms though please note that these may also indicate other diseases as well:

• Fever (Over 38.3ºC or below 36ºC) accompanied by chills and tremors
• An increased heart rate of more than 90 beats/min
• Confused mental state
• Acute headache
• Excessive sleepiness
• Acute pain.
• Marked oedema i.e. accumulation of fluid in the body indicated by swelling of body parts (legs, hands, face, belly etc)
• High blood sugar, typically over >110mg/dL or 7.7mmol/L
• Low urine output below 0.5mL/kg/h
• Infection in placenta or uterus that is not healing
• You have some other infection and you witness sudden rapid breathing and breathlessness
• You have conducted diagnostic tests for white blood cells and the results are not within the normal range
• Acute diarrhoea, muscle pain, fainting, vomiting, nausea and/or cold skin
• You have an infection and you have preterm breakage of the sac.

How to Treat Blood Infection During Pregnancy

Treatment involves that restoration of the tissue functions, cell metabolism, oxygen circulation and the safety of the foetus, etc. Treatment should ideally be done in the ICU. Here are a few ways to do it:

• Antibiotics: Sepsis in its early stages can be treated with only antibiotics. Typically, one antibiotic is used to prevent resistance. In genital sepsis, 2 to 3 antibiotics are combined. In polymicrobial infections, broad-spectrum antibiotics like penicillin, aminoglycoside, and clindamycin, vancomycin, or piperacillin-tazobactam are used. This must be done with caution because antibiotics often change their properties in pregnant women and some antibiotics are harmful to the foetus.
• Intravenous fluids: These are often given but with caution so that there is no excess fluid infusion that ideally should be looked at after the first 6 hours of the start of this treatment. Albumin could also be given to such patients under certain medical conditions. Side effects of this treatment could be bleeding and kidney dysfunction.
• Medications: Dopamine and noradrenaline are used to control uteroplacental blood flow while the mother is being treated. These drugs must be administered with caution to keep the baby stable. According to one study, noradrenaline is the preferred choice to reduce side effects.
• Oxygen supply: This is required when sepsis affects the lungs and results in breathing problems. Oxygen can be supplied with:
  • nasal cannula
  • nebulizers
  • in severe cases via invasive mechanical ventilation

In pregnant women, oxygen saturation must be 95% and not 90%, as in general sepsis patients. This is important to prevent the high chances of extreme side effects on the foetus.

How to Prevent Sepsis During Pregnancy

Here’s how you can lower your chances of contracting blood infection during pregnancy.

• Stay Away From People Who are Sick: Try to avoid contracting any infections by staying away from unwell people, avoiding outside food, etc.
• Maintain Good Hygiene: Always wash your hands thoroughly before cooking and eating.
• Get Vaccinated: Take your vaccines on time.
• Seek Medical Help: If you suspect an infection of any sort, seek immediate medical attention because early diagnosis and treatment can help prevent the spread of infection to the blood.
• Be Careful If You Have Any Medical Condition: If you suffer from diabetes, cancer, and younger women must be very careful about personal hygiene and infections because they already have a compromised immune system that increases chances of sepsis.

When to Seek Medical Help

Seek medical help in the following cases:

• If you have any of the following infections:
  • Escherichia coli
  • Hemophilus influenzae
  • Klebsiella
  • Enterobacter
  • Proteus
  • Pseudomonas
  • Serratia
  • Pneumococcus
  • Streptococcus, groups A, B, and D
  • Enterococcus
  • Staphylococcus aureus
  • Listeria monocytogenes
  • Bacteroides
  • Clostridium perfringens
  • Fusobacterium
  • Peptococcus
  • Peptostreptococcus
  • Pyelonephritis
  • Malaria
  • Listeriosis
  • Viral hepatitis (E)
  • Varicella pneumonia
  • Coccidioidomycosis
  • Aspiration pneumonia
  • HIV-associated infections
  • Toxoplasmosis
  • Cytomegalovirus
  • Gastrointestinal infections
  • Disseminated herpes

(Please note this list may not be exhaustive)

• If you have done prescribed diagnostic tests that display:
  • Acute/constant anaemia
  • Abnormal count of White blood cells, Creatinine, Plasma C reactive protein, INR, Platelet count, Plasma procalcitonin, bilirubin or any other test reports
• If your blood pressure (using a blood pressure monitor) shows abnormal counts.
• If you feel respiratory problems associated with an infection. If you have an oximeter (device to check oxygen in your body) at home, you can check your oxygen saturation. You should seek medical attention if the readings are not normal.
• If you have an infection and your urine flow decreases, your heart rate increases, you have breathing problems and/or have severe gastrointestinal problems that keep recurring.
• If there are blood coagulation problems that can be indicated if you get wounds and blood flow does not stop easily, there is blood in your bowels, easy bruising, nosebleeds etc.
• You have abnormal vaginal discharge.
• If you have had an abortion that is not well performed and you have an infection.
• You have come back from the hospital and suspect a hospital-acquired infection.
• If you have any other severe illness that is not improving with prescribed medication.

Please adhere to all above details because sepsis can also become a life threat if not identified and treated in time.

Also Read:

Getting Tattoo during Pregnancy
Bleeding in Late Pregnancy
Group B Streptococcus (GBS) in Pregnancy