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Septic shock complicating delivery may be caused by infection from the genital tract, but can occur with any source of infection, for example a urinary tract or chest infection.

The development of shock is due to a dysregulated systemic inflammatory and immune response to microbial invasion that results in vasodilatation, hypotension and organ dysfunction. Septic patients have a metabolic acidosis with a raised lactate, detectable on sampling of arterial or venous blood.

In trauma patients, sepsis is unlikely to cause shock at presentation. It is most likely to develop later in patients with penetrating abdominal injuries and in whom the peritoneal cavity has been contaminated by intestinal contents.

The key to management is a high degree of suspicion, rapid diagnosis and urgent treatment, as perinatal sepsis is a rapidly progressive disease. Pregnant women with septic shock will require early referral to critical care. See Chapter 7 for further information on maternal septic shock.