Summary: The need for a guideline on the management of sepsis in pregnancy was identified by the 2007 Confidential Enquiry into Maternal Deaths. Sepsis in pregnancy remains an important cause of maternal death in the UK. In 2003–2005 there were 13 direct deaths from genital tract sepsis in pregnancy, five related to pregnancy complications prior to 24 weeks of gestation and eight related to sepsis from 24 weeks of gestation, arising before or during labour. Sadly, substandard care was identified in many of the cases, in particular lack of recognition of the signs of sepsis and a lack of guidelines on the investigation and management of genital tract sepsis.
Between 2006 and 2008 sepsis rose to be the leading cause of direct maternal deaths in the UK, with deaths due to group A streptococcal infection (GAS) rising to 13 women. Severe sepsis with acute organ dysfunction has a mortality rate of 20 to 40%, which increases to 60% if septic shock develops. Studies in the non-pregnant population have found that the survival rates following sepsis are related to early recognition and initiation of treatment.
The scope of this guideline covers the recognition and management of serious bacterial illness in the antenatal and intrapartum periods, arising in the genital tract or elsewhere, and its management in secondary care. Sepsis arising due to viral, fungal or other infectious agents is outside the scope of this guideline. The population covered by this guideline includes pregnant women suspected of, or diagnosed with, serious bacterial sepsis in primary or secondary healthcare.
Bacterial sepsis following pregnancy in the puerperium is the subject of a separate Green-top Guideline Green-top Guideline No. 64b Bacterial Sepsis following Pregnancy.
COVID disclaimer: This guideline was developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to the emergence of COVID-19.
Version history: This is the first edition of this guideline; the second edition of this guideline is currently in development.
Developer declaration of interests: Available on request.