07:59am Sunday 26 January 2020

RCOG release: Early referral of maternal sepsis could be life saving, say new guidelines

Sepsis is caused by a bacterial infection and during and after pregnancy is an important cause of maternal death in the UK. This was highlighted in the 2011 Confidential Enquiry into maternal deaths.

The two new Green-top Guidelines focus on sepsis during pregnancy (64a) and sepsis following pregnancy (64b). 

Between 2006–2008 there were 29 deaths from sepsis, including 13 direct deaths from Streptococcus pyogenes genital tract sepsis in pregnancy. Lack of recognition of the signs of sepsis and a lack of guidelines on its management were both identified as problems in the report.

Risk factors for sepsis include obesity, diabetes, anaemia, history of pelvic infection or Group B Streptococcal infection and black or minority ethnic origin, say the guidelines.

All healthcare professionals should be aware of the symptoms and signs of maternal sepsis and critical illness and of the rapid, potentially lethal course of severe sepsis and septic shock. Suspicion of significant sepsis should trigger urgent referral to secondary care, say the guidelines.
Clinical signs suggestive of sepsis during pregnancy include one or more of the following: fever, hypothermia, increased heart rate, rapid breathing, hypoxia, low blood pressure, reduced passing of urine, impaired consciousness and failure to respond to treatment.

However symptoms and signs of sepsis in the pregnant woman may be less distinctive than in the non-pregnant population and are not necessarily present in all cases, therefore a high index of suspicion is necessary. 

If sepsis is suspected, regular frequent observations should be made and there should be urgent referral to the critical care team in severe/ rapidly deteriorating cases and involvement of a consultant obstetrician.

The expert advice of a consultant microbiologist or infectious disease physician should be sought urgently when serious sepsis is suspected.

If genital tract sepsis is suspected, prompt, early treatment with a combination of high-dose broad-spectrum intravenous antibiotics may be lifesaving, say the guidelines.

The guidelines also look at how Group A Strep and MRSA are easily transmitted via the hands of healthcare workers and via close contact in households. Local infection control guidelines should be followed for hospital–specific isolation and contact precautions.

The guideline on sepsis following birth looks at management of sepsis after birth until six weeks postnatally in response to the findings of the Eighth Report on Confidential Enquiries into maternal deaths in the UK, which showed an increase of Group A Strep (GAS) infection.

Risk factors for sepsis after birth are similar to that of sepsis during pregnancy. Common symptoms of sepsis following birth include fever, diarrhoea, vomiting, abdominal pain, vaginal discharge and signs of infection in caesarean wounds.

Sepsis should be considered in all recently delivered women who feel unwell and have fever or hypothermia, say the guidelines.

Community carers should be aware of the importance of early referral to hospital of recently delivered women who feel unwell and have fever, and should be aware of the possibility of sepsis as early referral to hospital may be life saving.

Dr Philip Owen, Chair of the Green-top Guideline Committee, said:

“All pregnant and recently delivered women need to be informed of the signs and symptoms of genital tract infection and how to prevent its transmission. Advice to all women should include verbal and written information about its prevention, signs and symptoms and the need to seek advice early if concerned, as well as the importance of good personal hygiene.”


For more information please contact Naomi Weston, PR Officer, Royal College of Obstetricians and Gynaecologists:  nweston@rcog.org.uk  020 7772 6357


The Green-top Guideline on sepsis during pregnancy can be found here.

The Green-top Guideline on sepsis following pregnancy can be found here.

The Confidential Enquiries into maternal deaths can be found here.

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