The Hour That Counts

Two independent checks, one calculation each, written down — and every computed dose confirmed against the maximum recommended dose before it is given.

Tachycardia, tachypnoea and a modestly raised white cell count are all normal in the puerperium, so a general adult sepsis screen under-calls the obstetric patient. Her triggers are the obstetric ones: temperature above 38.0°C, heart rate above 120, respiratory rate above 30, systolic below 90, saturation below 95 per cent, and altered mental state. A lactate of 4.2 mmol/L is in the severe band.

Puerperal infection is a temperature of 38.0°C or higher on any two of the first ten days postpartum, excluding the first 24 hours, with temperatures taken at least four times a day.