Sepsis and septic shock in pregnancy and the puerperium

It is 06:20. The postnatal ward calls about a woman delivered by caesarean a day ago who "just does not look right." She is febrile, tachycardic, tachypnoeic, confused and hypotensive. She was well at the midnight obs. This is sepsis until you prove otherwise, and the next hour will decide whether she lives. Maternal sepsis rewards the registrar who treats the patient in front of them and punishes the one who waits for the white cell count. This topic is that hour.^[5][9]

Overview and definition

Maternal sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, complicating pregnancy, birth or the puerperium. Septic shock is sepsis with circulatory and cellular or metabolic abnormality that substantially increases mortality — clinically, persisting hypotension needing vasopressors to hold a mean arterial pressure and a raised lactate despite adequate fluid.^[2][1]

Two facts frame everything. First, sepsis remains a leading direct cause of maternal death even where overall maternal mortality is low — a preventable killer that hides behind the normal physiological noise of pregnancy.^[9][17] Second, pregnancy itself disguises early sepsis: the tachycardia, the mild tachypnoea, the high cardiac output and low resistance, the modest leukocytosis of normal labour are all the septic patient's signature too.^[14][16]

^{[10] [11]}

References17ShowHide

1. [1]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021 Crit Care Med, 2021.PMID 34605781
2. [2]Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903338
3. [3]Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA, 2016.PMID 26903335
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