MATERNAL SEPSIS

In this blog, I’ll be reviewing maternal sepsis. I’ll be defining what maternal sepsis is, national statistics, the causes of maternal sepsis, the recommended screening and diagnostic criteria, assessment and monitoring recommendations, management recommendations, and the role of the Safe Motherhood Initiative Sepsis Bundle.

What is Maternal Sepsis: 

Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or postpartum period.

• Presentation: pregnant patients appear clinically well prior to rapid deterioration  with the development of septic shock, multiple organ dysfunction syndrome, or death.  This is due to pregnancy-specific physiologic, mechanical, and immunological adaptations (JAMA, 2021).

National Statistics:

Maternal sepsis is the second leading cause of maternal mortality in the United States.  Among all maternal deaths in the U.S., 13% are attributed to infection or sepsis, with case fatality rates as high as 10% to 30% in the obstetric population (JAMA, 2021). It is estimated that 4 to 10 per 10,000 live births are complicated by maternal sepsis (ACNM, 2018).

Causes of Maternal Sepsis:

Screening & Diagnostic Criteria:

The use of a maternal early warning system (MEWS) is recommended.  This is a set of specific vital sign and physical exam findings that prompt a bedside evaluation and/or work-up (see ACOG’s MEWS example below)

Management Recommendations:

Survivability requires early detection, prompt recognition of the source of infection, and targeted therapy

Delayed antibiotics > 1 hour = increased mortality

How the ACOG Safe Motherhood Initiative (SMI) Sepsis Bundle Reduces Maternal Morbidity:

The SMI is a collaborative initiative between ACOG and the New York State Department of Health (NYSDOH) to improve patient safety and raise awareness about risk factors that contribute towards maternal morbidity & mortality.  The SMI supports provider readiness and recognition through the availability of education, standardized sepsis work-up criteria and diagnostic tools. The SMI supports timely provider response and reporting by the availability of a standardized sepsis management algorithm, recommended criteria for consultation and transfer to a higher level of care, and case debriefing tools.

If you are in need of a medical legal expert specific to a maternal sepsis case, contact Barber Medical Legal Nurse Consulting, LLC

Resources:

ACNM, 2018. Recognition and Treatment of Sepsis in Pregnancy

ACOG, 2020. Maternal Safety Bundle for Sepsis in Pregnancy

JAMA Network Open. 2021;4(9): Perinatal Outcomes Among Patients with Sepsis During Pregnancy

P.S. Comment and Share your experience with a maternal sepsis case.  Was the case a wrongful death case or missed diagnosis, other?