Intrapartum SIRS does not predict infection
B Holst, P Hamer, S Johnson, N Tailor, RE Collis
University Hospital of Wales, Cardiff, UK
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.