Yancey M K, Duff P
Maternal-Fetal Medicine Service, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Obstet Gynecol Clin North Am. 1995 Mar;22(1):91-109.
While infections are a common complication of pregnancy, bacteremia and septic shock are relatively rare. Efforts to prevent serious bacterial infections are the most effective means of minimizing maternal and fetal morbidity. Screening for first trimester asymptomatic bacteriuria, prompt and thorough evaluation of suspected bacterial infections, and conscientious intrapartum assessment can have a significant impact in decreasing localized bacterial infections. The prompt recognition and institution of antimicrobial therapy in women suspected of having systemic infections is of paramount importance in reducing the incidence of serious maternal morbidity and mortality. Initial efforts in the treatment of sepsis should be directed at intravascular volume expansion in an effort to improve myocardial performance and tissue oxygenation. Inotropic agents occasionally may be necessary; however, they should be used with caution and only after adequate volume expansion has been provided. Adequate antimicrobial therapy requires treatment with multiagent therapy, providing coverage for the wide variety of genital tract pathogens.
虽然感染是妊娠常见的并发症，但菌血症和感染性休克相对少见。预防严重细菌感染的措施是将母婴发病率降至最低的最有效手段。筛查孕早期无症状菌尿、对疑似细菌感染进行及时全面的评估以及认真进行产时评估，对减少局部细菌感染会产生重大影响。对疑似患有全身感染的女性迅速识别并开始抗菌治疗，对于降低严重孕产妇发病和死亡的发生率至关重要。脓毒症治疗的初始措施应针对血管内容量扩充，以改善心肌功能和组织氧合。有时可能需要使用正性肌力药物；然而，应谨慎使用，且仅在已提供足够的容量扩充后使用。充分的抗菌治疗需要采用多药联合治疗，以覆盖多种生殖道病原体。
