When should vasopressors be started in maternal septic shock?

When should vasopressors be started in maternal septic shock?

• A. Immediately on diagnosis
• B. After 24 hours if hypotension persists
• C. If hypotension persists after adequate fluid resuscitation to maintain MAP ≥ 65 mmHg
• D. Only after ICU transfer

Answer: (C)

In septic shock, the priority is to restore perfusion by balancing fluids and vasopressors. Begin with adequate fluid resuscitation using isotonic crystalloids and reassess blood pressure and organ perfusion. Vasopressors are added when hypotension persists after this fluid challenge, with the goal of maintaining a mean arterial pressure of at least 65 mmHg. This threshold helps ensure sufficient maternal and fetal/perfusion of vital organs while avoiding unnecessary vasoconstriction before volume status is optimized. Starting vasopressors immediately on diagnosis or waiting 24 hours without response can be inappropriate, and delaying care until transfer to an intensive care setting risks ongoing hypoperfusion. In obstetric septic shock, norepinephrine is commonly used as the first-line vasopressor, titrated to reach the MAP target, with adjustments as needed.

In septic shock, the priority is to restore perfusion by balancing fluids and vasopressors. Begin with adequate fluid resuscitation using isotonic crystalloids and reassess blood pressure and organ perfusion. Vasopressors are added when hypotension persists after this fluid challenge, with the goal of maintaining a mean arterial pressure of at least 65 mmHg. This threshold helps ensure sufficient maternal and fetal/perfusion of vital organs while avoiding unnecessary vasoconstriction before volume status is optimized. Starting vasopressors immediately on diagnosis or waiting 24 hours without response can be inappropriate, and delaying care until transfer to an intensive care setting risks ongoing hypoperfusion. In obstetric septic shock, norepinephrine is commonly used as the first-line vasopressor, titrated to reach the MAP target, with adjustments as needed.