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Worldwide sepsis causes 1 in 10 maternal deaths and is the third commonest cause of direct maternal death (Turner, 2019). To reduce avoidable deaths, women with sepsis need to be recognised so that treatment can be initiated early.

In 2017 the World Health Organization (WHO) defined maternal sepsis as a life‐threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post‐abortion, or postpartum period (Figure 7.1).

Figure 7.1 Approach for implementation of the new WHO definition of maternal sepsis

Source: Statement on maternal sepsis, WHO. © 2017 WHO

The Third International Consensus (2016) definition of sepsis (SEPSIS‐3) for the whole adult population is that sepsis is a life‐threatening organ dysfunction due to a dysregulated host response to infection.

Septic shock is a life‐threatening condition that is characterised by low blood pressure despite adequate fluid replacement, and organ dysfunction or failure. The Third International Consensus definition (SEPSIS‐3) of septic shock is persisting hypotension requiring vasopressors to maintain mean arterial pressure of 65 mmHg or more and having a serum lactate of greater than 2 mmol/l despite adequate volume resuscitation.

These definitions depend on the identification of organ dysfunction in the presence of infection. In the general adult population, a brief bedside tool such as the quick SOFA (sequential organ failure assessment) or qSOFA score is used as described in SEPSIS‐3. The qSOFA score evaluates the presence of three clinical criteria: systolic blood pressure ≤100 mmHg, respiratory rate ≥22 per minute and altered mental status. If two or more of these criteria are present the patient is at increased risk of a poor sepsis‐related outcome and urgent action is prompted. An obstetric modified qSOFA has been produced by the Society of Obstetric Medicine Australia and New Zealand and modifies the systolic blood pressure to ≤90 mmHg, respiratory rate ≥25 per minute and altered mental state. Table 7.1 summarises the organ damage by system caused by sepsis.

Table 7.1 Organ damage caused by sepsis

Source: Plant LA, Pacheco LD, Louis JM. Sepsis during pregnancy and the puerperium. SMFM Consult Series No. 47: Am J Obstet Gynecol 2019; 220(4): B2–B10. © 2019 Elsevier

Organ system	Clinical features
Central nervous system	Altered mental status
Cardiovascular system dysfunction	Hypotension from vasodilatation and third spacing; myocardial
Pulmonary system	Acute respiratory distress syndrome (ARDS)
Gastrointestinal	Paralytic Ileus
Hepatic system	Hepatic failure or abnormal transaminases
Urinary system	Oliguria or acute kidney injury
Haematological system	Thrombocytopenia or disseminated intravascular coagulation
Endocrine system	Adrenal dysfunction and increased insulin resistance

Although people with sepsis may have an infection, fever is not always present. The signs and symptoms of sepsis can be non‐specific and can be missed if clinicians do not think ‘Could this be sepsis?’

The key actions for the diagnosis and management of sepsis (Knight et al., 2014, 2017) are:

 Timely recognition

 Fast administration of antibiotics

 Quick involvement of experts – senior review is essential