Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis

Obstet Gynecol. 2021 Aug 1;138(2):289-304. doi: 10.1097/AOG.0000000000004471.

Abstract

Maternal sepsis is an obstetric emergency and a leading cause of maternal morbidity and mortality. 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. 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 postpartum patients, and measures to prevent poor outcomes in this population. Adverse pregnancy outcomes may occur in association with sepsis, and should be anticipated and prevented when possible, or managed appropriately when they occur. Using a standardized approach to the patient with suspected sepsis may reduce maternal morbidity and mortality.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Critical Illness
  • Female
  • Humans
  • Maternal Mortality
  • Postpartum Period
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis*
  • Pregnancy Complications, Infectious / microbiology
  • Pregnancy Complications, Infectious / therapy*
  • Pregnancy Outcome
  • Shock, Septic / diagnosis
  • Shock, Septic / therapy
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / mortality
  • Streptococcus pyogenes
  • Time Factors

Substances

  • Anti-Bacterial Agents