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Intrapartum SIRS does not predict infection

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Intrapartum SIRS does not predict infection

B Holst, P Hamer, S Johnson, N Tailor, RE Collis

University Hospital of Wales, Cardiff, UK 

•MSSB has high sensitivity
•Low specificity
•Only 40% culture-positive
•Maternity specific SIRS did not differentiate culture positive and negative women overall
•Temperature and Lactate were unhelpful
•A higher heart rate more likely to be culture positive
•A slightly lower WCC more likely to be culture positive
•4/10 women with positive blood cultures had temperature<38oC justifying lower threshold
With a high apparent prevalence of infection/sepsis (7% of all women who laboured) there are concerns about the over-treatment with antibiotics and the tendency for neonates to be treated prophylactically if mother is labelled as having sepsis

Maternity Specific SIRS criteria for the early identification and sepsis has been used for 2-years and audited over 6-months, in a large maternity unit. 192 women (6.3% of all labourers) were diagnosed and treated for possible infection/sepsis in the audit period.

77/192 (40%) of women were confirmed as having evidence of infection from positive cultures (blood, swabs, urine, placenta)

None of SIRS criteria or conventional biomarkers markers were able to distinguish culture-positive from culture negative SIRS. In particular temperature and lactate showed no utility, although a higher heart rate and slightly lower WCC were possibly more useful.

4/10 blood culture positive women had a temperature lower than the conventional 38oC on triggering the bundle, justifying this altered parameter in the “Maternity Specific Bundle!.

There is probably an over diagnosis of infection/sepsis using “maternity specific SIRS bundle with unnecessary antibiotics in mother and neonate, but late presentation of sepsis is NOT a feature.

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