1. Background & Importance

• Sepsis = leading direct cause of maternal death worldwide.

• In UK (MBRRACE), Group A Streptococcus (GAS) is the most frequent pathogen in fatal cases.

• Other common organisms: E. coli, Klebsiella, anaerobes, MRSA.

• Risk factors: obesity, diabetes, immunosuppression, prolonged rupture of membranes, GBS carriage, invasive procedures, retained products.

2. Definitions

• Sepsis = life-threatening organ dysfunction caused by dysregulated host response to infection.

• Septic shock = sepsis + circulatory/metabolic dysfunction requiring vasopressors.

• In pregnancy, physiological changes may mask signs (↑ HR, ↓ BP, ↑ WCC).

3. Recognition (High-yield)

• Clinical features: fever, tachycardia, tachypnoea, hypotension, rigors, altered mental state, oliguria.

• Red flags (maternal sepsis six “red” signs):

  • RR >25/min or SpO₂ <92% on air

  • SBP <90 mmHg or MAP <60

  • HR >130/min

  • New altered mental status

  • Oliguria (<0.5 mL/kg/h)

  • Non-blanching rash/lactate >2 mmol/L

4. Investigations

• Bloods: FBC, CRP, U&E, LFTs, lactate, coagulation.

• Cultures: blood cultures before antibiotics, urine, high vaginal/endocervical swabs, wound/pus.

• Imaging: CXR/CT/US if source suspected.

• Sepsis screen should be completed within 1 hour of recognition.

5. Immediate Management — “Sepsis 6 in pregnancy”

Within 1 hour:

1. High-flow O₂.

2. Take blood cultures.

3. IV broad-spectrum antibiotics (do not delay).

4. IV fluids (30 mL/kg crystalloid if hypotensive).

5. Measure lactate & FBC.

6. Monitor urine output (catheterise).

• Escalate early to senior obstetrician, anaesthetist, microbiology, ITU.

• Antibiotics: IV broad spectrum as per local policy (e.g., piperacillin-tazobactam ± clindamycin; consider carbapenem in severe sepsis). Tailor once culture results available.

• Surgical source control (evacuation of retained products, drainage of abscess, debridement of wound, removal of line).

6. Obstetric Considerations

• Pregnancy: sepsis increases maternal morbidity & mortality; can cause fetal hypoxia, preterm labour, IUFD.

• Delivery: urgent if source is intrauterine and woman is unstable; decision multidisciplinary.

• Anaesthesia: consider early anaesthetic involvement; avoid neuraxial block if coagulopathy/sepsis.

• Antibiotic prophylaxis: given in risk scenarios (PROM, GBS, CS).

7. Prevention

• Hand hygiene, aseptic technique, timely antibiotics in PROM/chorioamnionitis, minimise vaginal exams.

• Immunisation (influenza, pertussis).

• Prompt treatment of UTIs.

8. Key Exam Points (MRCOG SAQ/SBA)

• Most common cause of maternal death from sepsis in UK: Group A Strep.

• First step when suspecting sepsis: Give broad-spectrum IV antibiotics immediately — do not wait for cultures.

• Sepsis 6 actions — within 1 hour.

• Escalation: involve senior staff, ITU, microbiology early.

• Pregnancy physiology may mask sepsis signs → be vigilant.

• ✅ In summary for exams:

  • Recognise early — “red flags”.

  • Treat immediately with Sepsis 6 (antibiotics + fluids = lifesaving).

  • GAS is the most lethal pathogen.

  • Escalate, involve multidisciplinary team, and consider urgent delivery if source intrauterine.

For Guideline on Identification and Management of Maternal Sepsis During and Following Pregnancy click below 👇🏼