Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes

Objective: To report maternal and perinatal outcomes in obstetric patients with severe sepsis and septic shock. Methods: We performed a retrospective study of obstetric patients admitted to an intensive care unit (ICU) for severe sepsis/septic shock. Maternal clinical characteristics, hemodynamic profiles, laboratory findings, and perinatal outcomes were evaluated. Patients with severe sepsis (N = 20) and septic shock (N = 10) were compared using Fisher's Exact and Mann-Whitney U tests. Results: Pyelonephritis was the most common etiology overall (37%) and acute respiratory distress syndrome (ARDS) was the most common organ injury in both severe sepsis (50%) and septic shock (80%). Liver dysfunction was present in cases with increased morbidity as a late finding and was the least frequent organ injury. Patients with septic shock had significantly higher rates of disseminated intravascular coagulation (DIC) (p = 0.01), altered mental status (p <= 0.001), total bilirubin >4 mg/dl (p = 0.04), failure in >= 3 organ systems (70% vs. 15%, p = 0.005), and maternal death (30% vs. 0%, p = 0.03). All patients with septic shock were delivered during hospitalization vs. 40% with severe sepsis. 71% of viable pregnancies required emergent cesarean delivery, and 50% of these for worsening respiratory function. Conclusions: ARDS is frequently found in critically ill obstetric patients with severe sepsis/septic shock and is associated with a high risk of emergent cesarean delivery.