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O&G CasesCritical care — maternal resuscitation

O&G Cases · Critical care — maternal resuscitation

Maternal sepsis on the postnatal ward — resuscitation station

Timed resuscitation station: postpartum septic shock with a wound source. Tests pregnancy-aware recognition, the one-hour bundle with empiric antibiotic doses, vasopressor escalation, source control, the group A strep escalation, and team and family communication. Includes a minute-by-minute assessor timeline, marking domains, assessor key and fail criteria.

resus4 min readVerification in progress

Target exams

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Target exams

FRANZCOGMRCOGABOG
Prompt
At 14:00 the postnatal ward calls about a 31-year-old woman delivered by emergency caesarean 36 hours ago for failure to progress at full dilatation. She is drowsy and shivering, temperature 39.1, heart rate 134, respiratory rate 32, blood pressure 82/46, oxygen saturation 92 percent on air. Her wound is tender with a 2 cm dehiscent area, her lochia is malodorous, and a venous lactate returns at 4.3 mmol/L. You are the obstetric registrar; the obstetric consultant and anaesthetist are 15 minutes away. The assessor runs the timeline and challenges your decisions.

Station brief

Format. Resuscitation station, 12 minutes, run against a clock. You are the obstetric registrar on the postnatal ward. The assessor runs the timeline, plays the midwife and the anaesthetist, and challenges your decisions on antibiotics, fluids, vasopressors and source control. [1][5]

Candidate instruction. Take charge of the resuscitation of a woman in postpartum septic shock. Verbalise your recognition, your bundle steps with drug names and doses, your source-control decision, and your escalation to intensive care. You will be challenged on antibiotic timing and on the qSOFA-reassurance trap; the assessor is testing whether you hold the line on the one-hour rule.[1][15]

Obstetrics & Gynaecology Pro

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References6ShowHide
  1. [1]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 Crit Care Med, 2021.PMID 34605781
  2. [5]Plante LA, Pacheco LD, Louis JM SMFM Consult Series #47: Sepsis during pregnancy and the puerperium Am J Obstet Gynecol, 2019.PMID 30684460
  3. [9]Acosta CD, Knight M Sepsis and maternal mortality Curr Opin Obstet Gynecol, 2013.PMID 23385771
  4. [10]Bauer ME, Housey M, Bauer ST, et al. Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case-Control Study Anesth Analg, 2019.PMID 31743182
  5. [11]Albright CM, Has P, Rouse DJ, et al. Internal Validation of the Sepsis in Obstetrics Score to Identify Risk of Morbidity From Sepsis in Pregnancy Obstet Gynecol, 2017.PMID 28885400
  6. [15]Bowyer L, Robinson HL, Barrett H, et al. SOMANZ guidelines for the investigation and management sepsis in pregnancy Aust N Z J Obstet Gynaecol, 2017.PMID 28670748
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