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

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

Current Opinion in Anaesthesiology: June 2014 - Volume 27 - Issue 3 - p 259–266
doi: 10.1097/ACO.0000000000000077
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Wiebke Gogarten and Dorothee Bremerich

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.

aDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston Massachusetts, USA

bDepartment of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

cDepartment of Anesthesia, Faculty of Medicine, Harvard Medical School, Boston, Maassachusetts, USA

Correspondence to Dr Lawrence C. Tsen, Brigham and Women's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, CWN L1, 75 Francis Street, Boston, MA 02115, USA. Tel: +1 617 732 8216; e-mail: ltsen@zeus.bwh.harvard.edu

© 2014 Lippincott Williams & Wilkins, Inc.