DO PHYSIOLOGICAL-CHANGES OCCURRING IN PRE GNANCY FAVOR THE SEVERITY OF OBSTETRICAL INFECTIONS

Infection-induced maternal mortality reaches 1 to 5 per 100000 deliver ies. The main causes of severe sepsis during pregnancy are pyelonephri tis and post-partum endometritis. The frequency of septic shock due to Escherichia coli has been greatly reduced by screening and early anti biotic treatment of urinary tract infection. Three to 40 percent of pr egnant women develop chorioamnionitis after premature rupture of membr anes with a high risk of endometritis. Patients with obstetrical infec tious complications represent 0.06 to 0.48 percent of intensive care a dmissions, overall mortality being 0 to 22 percent. However, compared with the usual mortality observed in severe sepsis, this obstetrical m ortality is low. Important changes in immune functions occur during pr egnancy. The sepsis-induced systemic inflammatory response syndrome mi ght be facilitated by the basal stimulation of the immune system. Sept ic vascular and visceral complications are enhanced by the latent stat e of intravascular coagulation occuring in the peripartum. The circula tory and metabolic changes of normal pregnant women might disturb the adaptative mechanisms allowing patients to cope with septic injury. On the other hand, experimental data are consistent with a protective ef fect of oestrogen hormones on the vascular reactivity during severe se psis.