Challenging infections in pregnancy: a multiparametric approach

Despite advances in medical knowledge, infection still kills pregnant women. Early signs of sepsis may be missed or overlooked by busy healthcare workers, some with little experience of infections, and it can be difficult to recognise symptoms in a woman where infections present in subtle ways. The pregnant woman's immune system is compromised and she may have other reasons for malaise, flushes, miscellaneous aches, nausea, vomiting and abdominal pain, all of which could herald sepsis. This review is intended to cover basic microbiology germane to the diagnosis and understanding of infection, and combine this with microbiologically orientated aspects of clinical skills and pertinent history taking. These parameters, together with appropriate laboratory tests, can help the clinician spot infection early, and point towards the identification of the underlying causative agent. A review of antimicrobials, the place of immunoglobulin and other adjunctive therapies completes the multiparametric and pragmatic approach to diagnosis and management of serious infection in pregnancy.Accepted manuscript - 12 month embarg