By Margaret Garcia, Director of Perinatal Services

Maternal Sepsis Week, observed from May 12-18th, serves as a crucial opportunity to raise awareness about this pressing issue and mobilize efforts to prevent and manage maternal sepsis effectively. By shining a spotlight on maternal sepsis, we can amplify advocacy efforts, promote education, and drive policy changes aimed at improving maternal healthcare outcomes globally.

During Maternal Sepsis Week, healthcare professionals, policymakers, advocacy groups, and individuals affected by maternal sepsis come together to:

  1. Raise Awareness: Maternal Sepsis Week provides a platform to educate the public about the risk factors, signs, and symptoms of maternal sepsis. By increasing awareness, we can empower individuals to recognize the warning signs and seek timely medical attention.
  2. Advocate for Policy Changes: Maternal Sepsis Week advocates for policies and practices that prioritize maternal health and ensure access to quality healthcare services for pregnant individuals. This includes advocating for improved infection prevention measures, timely detection of sepsis, and appropriate management strategies.
  3. Support Affected Individuals: Maternal Sepsis Week offers support and solidarity to individuals who have experienced maternal sepsis, as well as their families and caregivers. It provides a platform for sharing stories, seeking resources, and fostering a sense of community among those impacted by this condition.

By coming together during Maternal Sepsis Week, we can make significant strides towards reducing maternal mortality rates and ensuring safer pregnancies and childbirth experiences for all.

What is Maternal Sepsis?

Sepsis is the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and death. According to the World Health Organization maternal sepsis refers to sepsis that results from infection during pregnancy, childbirth, post-abortion, or postpartum period.  The most common cause of maternal sepsis is a severe bacterial infection of the uterus during pregnancy or immediately after childbirth. Maternal sepsis could also be caused by a urinary infection, or pneumonia. Pregnant women who have a chronic condition impacting one of their organs are the most at risk for maternal sepsis. A recent analysis found that 23% of all maternal deaths in the U.S. are related to sepsis.  The U.S. has the third highest rate of maternal mortality of all high-income countries.

Sepsis in pregnancy is associated with an increased risk of preterm birth, prolonged recovery, stillbirth, and maternal death.  Risk factors associated with developing maternal sepsis include not having given birth before (nulliparity), black race, and public or no health insurance. Other childbirth-related (obstetric) risk factors include cesarean delivery, use of assisted reproductive technologies, and multiple births (e.g. twins or triplets). The Society for Maternal Fetal Medicine recently released new recommendations for the diagnosis and treatment of sepsis, including that sepsis and septic shock be considered medical emergencies. Treatment of sepsis in pregnancy should follow the same basic principles as treatment of patients who are not pregnant.  The Maternal Mortality Review Committee of the CDC recommends that health facilities have sepsis protocols in place and used by staff members as one strategy to prevent future pregnancy-related deaths.

Maternal sepsis is a complex condition that requires prompt recognition and treatment to improve outcomes for pregnant individuals and their newborns.

Signs and Symptoms of Maternal Sepsis

Early recognition in a pregnant or postpartum patient can be a challenge as the normal physiologic changes of pregnancy may mask the signs and symptoms of sepsis. Bedside assessment tools may aid in the detection of maternal sepsis. Although there are no standardized criteria to diagnose maternal sepsis, vital signs changes are an early indicator of infection. However, these early vital sign changes may be dismissed as normal physiologic changes of pregnancy such as an increase in heart rate, and decrease in blood pressure.   Additionally, external influences (e.g., blood loss during delivery, common infections, fluid administration, medications, and effects of anesthesia) may further confuse the clinical picture. Often there is no obvious source of infection in maternal sepsis, which makes recognition more challenging and may result in delays in treatment and source control.

Because the symptoms of maternal sepsis are often nonspecific, health care professionals need to maintain a high index of suspicion.  The Society for Maternal-Fetal Medicine recommends that health care professionals consider the diagnosis of sepsis in pregnant patients with otherwise unexplained end-organ damage in the presence of an infectious process, regardless of the presence of a fever.   The maternal immune response in pregnancy is decreased to protect the immunologically distinct fetus.  As a result, a pregnant woman has a predisposition for developing severe bacterial, fungal, or viral infections.  Primary sites of infection in pregnancy are the urinary tract (pyelonephritis), pelvic structures (chorioamnionitis and endometritis), surgical wounds (cesarean birth), and breast (mastitis). Maternal sepsis can present with multiple and varied symptoms such as lethargy, chills and rigors, generalized malaise, rashes, lower abdominal or pelvic pain, foul lochia, contractions, malodorous or discolored leaking of fluid from the vagina, and breast engorgement. Signs of maternal sepsis include fever or hypothermia, tachycardia, hypotension, uterine tenderness, preterm labor or preterm rupture of membranes, altered mental status, and end-organ dysfunction.

Identifying infection or predicting mortality in pregnant or postpartum patients remains unknown, it is recommend a step-wise approach, using a simple bedside screening tool such as MEOWS, followed by further evaluation for evidence of end-organ damage. Vital signs (eg, temperature, heart rate and respiratory rate) should be screened along with most recent white blood cell count within 24 hours. If any two of these four parameters are positive, source-directed antibiotics and intravenous fluids are administered, and further evaluation is recommended.

The second diagnostic step involves an evaluation for end-organ injury screening for sepsis, using the Centers for Medicare & Medicaid Services criteria for end-organ injury modified to account for normal maternal physiologic changes.  Implementing sepsis bundles to facilitate rapid escalation of care is vital. Timely and targeted antibiotic therapy and fluid resuscitation are critical for survival in patients with suspected sepsis. Once diagnosed, a search for etiologies and early application of source control measures will further reduce harms. If the patient is in septic shock or not responding to initial treatment, multidisciplinary consultation and escalation of care is necessary. Health care professionals should be aware of the unique complications of sepsis in critically ill pregnant and recently delivered patients.

Conclusion

In conclusion, maternal sepsis is a leading cause of maternal morbidity and mortality. Recognition of maternal sepsis remains a challenge for health care workers as the signs and symptoms of maternal sepsis often overlap with the normal physiologic changes of pregnancy. Implementation of a simple bedside screen with immediate evaluation if the screen is positive may aid in the early diagnosis of maternal sepsis and timely treatment. All obstetric health care professionals should have regular training and education on early recognition of sepsis, signs and symptoms, and the need for prompt assessment and treatment to prevent the rapid progression of sepsis to septic shock. Early recognition, focused evaluation, and expedient treatment tailored to the most likely etiology of maternal sepsis are the necessary steps to reduce maternal morbidity and mortality from sepsis.

For more information about maternal sepsis and how you can get involved, please visit Maternal Sepsis Alliance and World Health Organization.

To schedule an appointment, call us at 281-341-3085. Our team of healthcare professionals are dedicated to providing you with the best care and guidance for all of your maternal and perinatal needs.

 

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