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

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

Andrea Shields  1 , Viviana de Assis, Torre Halscott
Affiliations
Review

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

Andrea Shields et al. Obstet Gynecol. .

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.

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Conflict of interest statement

Financial Disclosure Dr. Shields is the Principal Investigator of an AHRQ grant for developing a simulation course on maternal cardiac arrest; provided volunteer expert testimony to KJS law; was an examiner for the ABOG specialty certifying exam; is a member of Varda5, LLC, a consulting company for patient safety and quality initiatives; is a member of Body Wisdom S.A., LLC, a wellness company; and is a member of Overlevende, LLC, for personal assets. The other authors did not report any potential conflicts of interest.

Figures

Fig. 1.
Fig. 1.. Most frequent sources of maternal infection associated with episodes of sepsis during and after hospitalization for delivery. Data from Hensley MK, Bauer ME, Admon LK, Prescott HC. Incidence of maternal sepsis and sepsis-related maternal deaths in the United States. JAMA 2019; 322:890‒92. doi: 10.1001/jama.2019.9818.
Shields. Pearls for Managing Maternal Sepsis. Obstet Gynecol 2021.
Figure
Figure
No available caption
See this image and copyright information in PMC

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