The purpose of this guideline is to provide guidance on the management of sepsis in the puerperium (i.e. sepsis developing after birth until 6 weeks postnatally), in response to the findings of the Centre for Maternal and Child Enquiries (CMACE) Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. This topic is particularly relevant as there has been a dramatic rise in maternal deaths attributable to group A beta-haemolytic streptococci (GAS) (three in 2000–2002 and 13 in 2006–2008).
The most common site of sepsis in the puerperium is the genital tract and in particular the uterus, resulting in endometritis. This guideline covers the recognition of febrile bacterial illness in the postpartum period – including postabortion sepsis – arising in the genital tract or elsewhere, investigations to identify and characterise sepsis in the puerperium, and management strategies. The population covered includes women in the puerperium (i.e. within 6 weeks of giving birth) with suspected or diagnosed bacterial sepsis in primary or secondary care. Sepsis in pregnancy is covered by a parallel guideline, Green-top Guideline No. 64a. Sepsis arising owing to viral or parasitic agents is outside the scope of this guideline. This guideline excludes mild to moderate illness in primary care.