Publication Date

Spring 2018

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Nisha Nair

Second Advisor

Matthew Garabedian

Third Advisor

Lori Olvera

Keywords

Sepsis, Perinatal, Obstetric, SIRS, Lactic acid

Abstract

This project was designed to evaluate outcomes following implementation of routine screening for sepsis in the obstetric population. A retrospective analysis of the electronic medical record of 204 women who met sepsis criteria using obstetric-adjusted systemic inflammatory response syndrome (SIRS) criteria and a source of infection was the method used. Outcomes were evaluated for neonates born to the women who developed sepsis during labor. The incidence of sepsis was 0.401 per1,000 and included those with antepartum, intrapartum, or postpartum admissions. The setting was a tertiary center with 5,075 deliveries over the study period. There were 92 (45.2%) who had sepsis, 87 (42.6%) who had severe sepsis, and 25 (12.3%) who met septic shock criteria. There were no deaths and two ICU admissions. Mean lactic acid level for women with sepsis (N=203) was 2.4 +- 1.3 mmol/L. Fourteen combinations of positive SIRS criteria were present; no combination was uniquely associated with the severity of sepsis. An Apgar score of ≤ 6 at one- and five-minutes of age was more likely when the mother developed sepsis in labor, odds ratio 12.1 (95% confidence interval, 7.86, 18.61) for the one-minute Apgar, and 3.06 (95% confidence interval 1.40, 6.75) for the five-minute Apgar score. The use of a standardized process for screening for sepsis provided for early identification and timely treatment of obstetric women with sepsis. Neonates born to women who met sepsis criteria in labor were more likely to require resuscitation at the time of birth than those born to women without sepsis.

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