Serum lactate as a prognostic indicator in pregnancy and post partum related sepsis

Background: Maternal sepsis is an infrequent, but important complication of pregnancy, childbirth and puerperium, resulting in significant maternal morbidity and mortality worldwide. This study determines the use of serum lactate as a prognostic tool in determining sepsis at an early stage. Methods: This study was conducted over 2 years on 40 patients admitted to the Department of Obstetrics and Gynaecology, Father Muller Medical College, Mangalore on in-patient basis with 2 or more signs and symptoms of infection, along with a suspected source of infection. Once sepsis was diagnosed, a baseline serum lactate level was measured followed by subsequent measurements after 12 h and 24 h. Results: Among the 40 patients studied, it was observed that not all patients with sepsis had elevated serum lactate levels. During the study, it was seen that patients with an initial increased lactate level (>2.2mmol) needed more aggressive treatment and a closer follow up during their stay in the hospital. Although all patients with elevated serum lactate had severe sepsis, lactate was not the only determining factor. In some patients with severe sepsis other laboratory parameters were altered, though their serum lactate levels were normal. Conclusion: Initial serum lactate levels though effective in predicting the prognosis of patients with severe sepsis, its credibility as an independent determinant of severe sepsis could not be established.