Post-caesarean sepsis on day 2 — emergency management station

Team-based emergency station: postoperative puerperal sepsis after caesarean. Tests the sepsis six bundle in the first hour, empirical antibiotic choices with doses, source control, communication with the team and the woman, and the documentation and governance that follow. Includes assessor key and marking domains.

Prompt

A 31-year-old G1P1 is 36 hours after an emergency caesarean under general anaesthesia for failure to progress. The midwife calls you to review: temperature 38.6 °C, heart rate 118 bpm, respiratory rate 24, blood pressure 102/62, oxygen saturation 95 percent on room air. The uterus is tender, lochia is offensive, the wound is clean. She is breastfeeding and looks unwell. You are the registrar; the consultant is in clinic and contactable.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on the postnatal ward. A midwife and a junior doctor are with you; the consultant is contactable in clinic. The assessor will run the clock and feed you new observations. ^[1]

Candidate instruction. Lead the first-hour management of suspected postoperative puerperal sepsis. Verbalise your actions, your drug orders with doses, your escalation triggers, and your communication with the team and the woman. ^[1]

References6Show

[1]Macones GA, Caughey AB, Wood SL, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (Part 2) Am J Obstet Gynecol, 2019.PMID 30995461
[2]Committee on Practice Bulletins-Obstetrics Practice Bulletin No. 183: Postpartum Hemorrhage Obstet Gynecol, 2017.PMID 28937571
[3]Bauchat JR, Habib AS, Carvalho B, et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia Anesth Analg, 2019.PMID 31082964
[4]Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity Am J Obstet Gynecol, 2007.PMID 17466699
[5]Sentilhes L, Sénat MV, Le Lous M, et al. Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery N Engl J Med, 2021.PMID 33913639
[6]Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery Cochrane Database Syst Rev, 2014.PMID 25479008

Post-caesarean sepsis on day 2 — emergency management station

Station brief

References6Show

[1]Macones GA, Caughey AB, Wood SL, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (Part 2) Am J Obstet Gynecol, 2019.PMID 30995461
[2]Committee on Practice Bulletins-Obstetrics Practice Bulletin No. 183: Postpartum Hemorrhage Obstet Gynecol, 2017.PMID 28937571
[3]Bauchat JR, Habib AS, Carvalho B, et al. Society for Obstetric Anesthesia and Perinatology Consensus Statement: Monitoring Recommendations for Prevention and Detection of Respiratory Depression Associated With Administration of Neuraxial Morphine for Cesarean Delivery Analgesia Anesth Analg, 2019.PMID 31082964
[4]Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity Am J Obstet Gynecol, 2007.PMID 17466699
[5]Sentilhes L, Sénat MV, Le Lous M, et al. Tranexamic Acid for the Prevention of Blood Loss after Cesarean Delivery N Engl J Med, 2021.PMID 33913639
[6]Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing cesarean delivery Cochrane Database Syst Rev, 2014.PMID 25479008