Patient Suffers Septic Shock Due to Retained Products of Conception

This case involves a patient who underwent a normal vaginal delivery. The placenta was examined by pathology and was reported as intact and normal-appearing. The patient was discharged home on time. A week post-delivery, the patient returned to the emergency room in respiratory distress with signs and symptoms of severe sepsis. She was admitted to the ICU and later died during that same hospitalization. An autopsy was performed and the cause of death was reported as sepsis.

Question(s) For Expert Witness

1. How frequently do you evaluate and treat patients suffering from sepsis?

2. What criteria are used to evaluate the need for initiation of broad-spectrum antibiotics and the hospital's sepsis protocol?

Expert Witness Response E-001199

I am board certified in both pulmonary and critical care medicine. I am actively practicing and I see peripartum patients in an academic practice setting. As an intensivist, I treat suspect and confirmed sepsis every week. We use widely accepted SCCM criteria for the detection and protocolized treatment of sepsis. Early antibiotics are clearly associated with improved sepsis survival. I have treated peripartum sepsis on multiple occasions. From an expert review perspective, I have reviewed at least 2 other cases of peripartum sepsis.