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Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0000000000000077
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Wiebke Gogarten and Dorothee Bremerich

Fetal optimization during maternal sepsis: relevance and response of the obstetric anesthesiologist

Chau, Anthonya,b; Tsen, Lawrence C.a,c

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Abstract

Purpose of review

In many labor and delivery units, the obstetric anesthesiologist is often responsible for managing and stabilizing the acutely septic parturient. The management of maternal sepsis has been summarized previously; this study will focus on the implications of maternal sepsis on the fetus, and ways to optimize fetal outcomes.

Recent findings

Although the complex pathophysiology of sepsis is being better understood, the incidence of maternal severe sepsis and deaths continues to increase. The differential sensitivities of systemic and uterine vasculature to catecholamines during pregnancy and the role of fetal inflammatory responses have recently been further elucidated. Additional investigations on methods of fetal monitoring are needed to assist in early identification of the compromised fetus. Despite decades of research, management of a septic parturient and her fetus, including the most appropriate resuscitation fluids, vasopressors and hemodynamic monitoring systems to maximize maternal and fetal outcomes, remain controversial.

Summary

In the setting of maternal sepsis, fetal optimization is frequently best accomplished by meeting maternal hemodynamic, oxygenization, and infection treatment goals. Understanding the circulatory and pathophysiologic changes that occur within the uteroplacental unit and fetus is essential to identifying and resolving potential conflicts between maternal and fetal management goals.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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