MODERN POSSIBILITIES OF SCREENING AND EARLY IDENTIFICATION OF CRITICAL CONDITIONS IN OBSTETRICS CAUSED BY SEPSIS
Keywords:
maternal sepsis, critical conditions, screening scalesAbstract
The issues of prediction and early diagnosis of emergency and critical conditions in obstetrics associated with sepsis are currently debatable. Recently, various screening systems for quantitative assessment of the severity of the condition of obstetric patients have been developed and are being implemented in clinical practice, designed to identify high-risk groups for developing organ dysfunctions, predict adverse outcomes, and make decisions regarding the place of provision and the amount of medical care. However, none of them can be accepted as the only and unified for practical use, due to the presence of both advantages and disadvantages. The rating systems recommended for early diagnosis of maternal sepsis are traditionally qSOFA, SIRS, SOS scales. The aim of the study was to assess the acceptability and informativeness of the qSOFA, SIRS, SOS scales in early diagnosis and prediction of adverse outcomes in septic conditions in obstetric practice. Each of the scales can be used in clinical obstetric practice. However, an isolated assessment of the patient's condition according to any one of them is not recommended; a comprehensive combined assessment is required for each of the screening scales. According to our data, the SOS scale was more informative in predicting critical conditions and screening for sepsis. The qSOFA and SIRS scales are convenient for institutions with limited resources and inaccessibility of rapid laboratory diagnostics, which absolutely does not exclude their widespread use in obstetric institutions of any level.
References
Интенсивная терапия сепсиса, септического шока в акушерстве. Национальный клинический протокол. Надырханова Н.С. и соавт. Ташкент, 2021, С. 6-122
Начальная интенсивная терапия септического шока в акушерстве. Клинические рекомендации. Общероссийская общественная организация «Федерация анестезиологов и реаниматологов», Российская общественная организация «Ассоциация акушерских анестезиологов и реаниматологов». Москва, 2018.
Albright CM, Has P, Rouse DJ, Hughes BL. Internal validation of the Sepsis in Obstetrics Score to identify risk of morbidity from sepsis in pregnancy. Obstet Gynecol 2017;130:747–55.
Armstrong BA, Betzold RD, May AK. Sepsis and Septic Shock Strategies. SurgClin North Am. 2017 Dec;97(6):1339-1379.
Bowyer L, Robinson HL, Barrett H, et al. SOMANZ guidelines for the investigation and management sepsis in pregnancy. Aust N Z J Obstet Gynaecol 2017;57:540–51.
Burlinson CEG, Sirounis D, Walley KR, Chau A. Sepsis in pregnancy and the puerperium. Int J Obstet Anesth. 2018 Jun 16. pii: S0959-289X(17)30463-6.
Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018 Jul 7;392(10141):75-87.
Friedman AM, Campbell ML, Kline CR, Wiesner S, D’Alton ME, Shields LE. Implementing Obstetric Early Warning Systems. AJP Rep 2018;8:e79–84.
Kendle AM, Louis J. Recognition and Treatment of Sepsis in Pregnancy. J Midwifery Womens Health. 2018 May;63(3):347-351.
Nishida O, Ogura H, Egi M, Fujishima S, et al. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016). AcuteMedSurg. 2018 Feb 5;5(1):3-89.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017;43:304–77.
Serafi m R., Gomes J.A., Salluh J., Póvoa P. A comparison of the Quick-SOFA and systemic infl ammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality. A systematic review and meta-anallysis. Chest. 2017; 153(3): 646–655. DOI: 10.1016/j.chest.2017.12.015.
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801–10.
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med (2021) 47:1181–1247 https://doi.org/10.1007/s00134-021-06506-y.
The WHO Global Maternal Sepsis Study (GLOSS) Research Group. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health 2020; 8: e661–71
World Health Organization. Statement on maternal sepsis. Geneva: WHO; 2017. Accessed 20 Feb 2017.
World Health Organization. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. WHO; 2020.
