Clinical Analysis Of 61 Cases Of Septic Shock In Pregnant And Puerperal Women

Background and ObjectiveSeptic Shock is a common and critical illness.It refers that the persistence of hypotension caused by severe infections,induces acute circulatory failure,which is still difficult to correct after adequate fluid resuscitation.Patients with septic shock have a high mortality rate,and early identification and initiation of treatment can reduce the mortality of septic shock.Puerperal infection refers to the invasion of the reproductive tract by the pathogen during deliery and puerperium,causing local or systemic infection,with an incidence of about 6%.Puerperal infection has always been one of the main causes of maternal mortality.Although previous reports have shown a decline in genital tract infections during the puerperium since the early 20th century,infection still accounts for 11%of pregnancy-related deaths in the United States.The report also shows that maternal severe sepsis has increased over the past decade.Obesity,chronic health conditions,lack of education and lack of antenatal care have increased the incidence and mortality of puerperal infections.Puerperal infection affects postpartum recovery,increases the likelihood of maternal readmission,affects breastfeeding and maternal and child relationships.In recent years,the number of pregnant women who produce puerperal infection has increased,and the number of sepsis caused by it has increased.If not treated promptly,septic shock may develop and even be life-threatening.There are many factors affecting gestational shock in pregnant women.At present,there are few related researches at home and abroad,and most of them are case reports.This study retrospectively analyzed the clinical data of septic shock cases admitted to obstetrics department of the First Affiliated Hospital of Zhengzhou University(our hospital).The aim is to explore effect of early clinical features and early diagnosis on pregnancy outcomes,providing better clinical diagnosis and treatment for pregnant women with septic shock.Clinical data and methods61 cases which were diagnosed as septic shock at the obstetric department of The First Affiliated Hospital of Zhengzhou University from January 2012 to December 2017.Among the 61 cases who were diagnosed as septic shock,37 patients were in the puerperium;26 cases of primipara,35 cases of maternal.According to the outcome,the patients were divided into the survival group(45 cases)and the death group(16 cases),then we analyzed the clinical features of the two groups.Diagnostic criteria for septic shock:(1)The obstetrically modified qSOFA(omqSOFA)score≥2分;(2)The obstetrically modified SOFA(omSOFA)score≥2分;(3)Persistent hypotension,vasoactive drugs need to maintain mean arterial pressure(MAP)after adequate volume recovery≥65 mmHg(1 mmHg=0.133 kPa),and after adequate volume recovery Blood lactate concentration>2 mmol/L。The basic characteristics,clinical characteristics and clinical laboratory indicators of the patients were collected to compare the differences among pregnant women with septic shock with different outcomes.Using SPSS 17.0 statistical software.The data of the normal distribution of quantitative data were expressed as mean±standard deviation(x±s),and t-test was used for comparison between groups;Non-normally distributed data were expressed as median(M)and interquartile range(Q),and comparisons between groups were performed using the Mann-Whitney U test.Qualitative data use cases(%)indicate that theχ~2 test or the continuous testχ~2 test is used for comparison between groups.With the death as the dependent variable,the independent variables were analyzed by univariate analysis,and then multivariate logistic regression analysis was used to determine the prognostic factors.The test levelɑis set to 0.05 The difference was statistically significant at P<0.05.Results1.Among the 61 cases who were diagnosed as septic shock,16 died(26.23%);2.When Septic shock was diagnosed,platelet(PLT)decreased,prothrombin time(PT)increased,fibrinogen(FIB)decreased and procalcitonin(PCT)increased in the death group compared with the survival group.The difference was statistically significant(P<0.05);3.The score system of acute physiology and chronic health evaluationⅡ(APACHEⅡ)of the death group was higher than that of the survival group.The difference was statistically significant(P<0.05);4.Compared with the survival groups of patients,the incidence of Premature rupture of membranes(PROM)and Multiple organ dysfunction syndrome(MODS)increased in the death group,and the difference was statistically significant(P<0.05).Conclusion1.After the diagnosis of septic shock,we need to pay attention to monitoring changes in clinical indicators such as PLT,PT,FIB,PCT;2.For patients with APACHEⅡhigh score or co-existence of PROM and MODS,we need to strengthen their clinical management to improve maternal outcomes of pregnant and puerperal women.