Maternal Sepsis - Causes, Symptoms, and Treatment

Introduction

Maternal sepsis ranks as the third leading cause of maternal death. This critical condition occurs when the body's response to infection results in harm to its tissues and organs during pregnancy, childbirth, post-abortion, or the postpartum period. The World Health Organization advises and assists countries in preventing maternal sepsis, ensuring early and accurate diagnosis, and providing timely and effective clinical care.

What Is Sepsis?

Sepsis is a serious medical emergency triggered by the body's strong response to an infection. Without prompt treatment, it can result in harm to tissues, organ failure, and death. Sepsis is an intense reaction of the body to an infection. When an infection occurs, the immune system attempts to combat it. However, in some cases, the immune system shifts from fighting the infection to harming normal tissues and organs, leading to widespread inflammation. Simultaneously, an abnormal chain reaction in the clotting system can cause the formation of blood clots in the blood vessels. This diminishes blood flow to various organs, potentially causing significant damage or failure.

What Are the Symptoms of Sepsis in Pregnancy?

Identifying maternal sepsis can be challenging as its symptoms overlap with typical changes in pregnancy, especially during labor. Early detection is vital, and prompt action is crucial. If one encounters any of these symptoms during the pregnancy or after leaving the hospital, contact the doctor or midwife promptly:

• Fever and chills.

• Extremely low body temperature.

• Foul-smelling vaginal discharge or bleeding.

• Rapid heartbeat.

• Dizziness.

• Reduced urine output.

• Fatigue.

• Blotchy or discolored skin.

What Are the Causes of Sepsis During Pregnancy?

The occurrence of sepsis during pregnancy or after childbirth can be attributed to infections related to pregnancy, such as those affecting the amniotic fluid, placenta, pelvic region, or wounds post a cesarean section or perineal tear. Additionally, common infections like pneumonia or urinary tract infections (UTIs) that anyone might experience can also lead to sepsis when they happen during pregnancy. Bacteria, viruses, or a combination of both can cause these infections, leading to sepsis.

What Is the Treatment of Sepsis During Pregnancy?

Treating sepsis during pregnancy involves swift action, primarily initiating antibiotics promptly. To identify the infection, the healthcare team may conduct blood tests, wound swabs, or a urine sample. Ultrasounds may also be performed.

Intravenous fluids through a drip may be administered to enhance blood pressure and organ blood flow. Specific antibiotics tailored to the suspected infection will be prescribed. If the cause remains unclear, multiple antibiotics might be necessary to address potential infections. Once the cause is identified, a specific antibiotic or, in certain cases, an antiviral medicine will be administered.

For pregnant individuals, the baby's heart rate will be monitored using a cardiotocograph (CTG). In some instances, early delivery of the baby may be required. If severely affected by sepsis, intensive care unit (ICU) admission may be necessary. Surgery could be recommended for issues like retained placenta or wound infections. Both pregnancy and sepsis elevate the risk of developing blood clots. To mitigate this risk, a blood-thinning medicine will be prescribed.

Is There Any Risk to the Baby in Maternal Sepsis?

Experiencing a fever during pregnancy may raise the risk of birth differences or congenital anomalies. In the presence of sepsis, the doctors will carefully weigh the considerations of waiting for the baby to be born at the expected time. This decision depends on factors such as:

• The number of weeks into pregnancy.

• The type of infection one has.

• The response to treatment and improvement.

• The baby's well-being is assessed through cardiotocograph (CTG) monitoring.

If it is determined that an early birth is necessary, one may receive injections of medicine to help mature the baby's lungs before delivery. Following birth, the baby will typically be given antibiotics and might need some time in the special care nursery or neonatal intensive care unit (NICU).

What Are the Complications of Sepsis During Pregnancy or After Birth?

Sepsis poses a significant risk during pregnancy or after birth, being a leading cause of maternal mortality in Australia, although the overall numbers are relatively low (approximately five deaths for every 100,000 pregnancies). For about half of the adults who experience sepsis, there can be lingering issues that persist for months or even years. These may include fatigue, difficulty concentrating, pain, or challenges with walking. The functions of vital organs like the kidneys, lungs, and heart may also be impaired. In certain cases, sepsis can lead to permanent disabilities, such as the loss of a limb. Additionally, some individuals may develop post-traumatic stress disorder (PTSD) or anxiety following a septic episode.

Does Having Sepsis Impact Future Pregnancies?

Experiencing sepsis during one pregnancy can impact future pregnancies, particularly if there is lasting damage to the organs or if surgery is required. If a cesarean section is performed due to the need for early or urgent delivery, it may influence the approach to future deliveries. The doctor will discuss the recommended duration to wait before planning another pregnancy and the potential risks associated with vaginal birth after a previous cesarean section. Surgical intervention may be advised in cases where some placental tissue remains in the uterus and contributes to the infection. This surgery carries a small risk of causing scarring to the uterine lining. Severe scarring may impede future pregnancies, but there is a surgical procedure available to address and remove such scar tissue.

How to Reduce the Risk of Maternal Sepsis?

While preventing every illness that might lead to sepsis is impossible, one can take measures to lower the risk. Follow these steps and consult with the doctor or midwife for personalized advice based on health needs:

• Schedule regular prenatal care appointments. The staff uses simple exams and tests to monitor the pregnancy and quickly address health concerns.

• Report any concerns promptly. Trust instincts: if someone senses something is wrong, seek medical attention immediately.

• Manage underlying conditions like diabetes. Keep the care team informed about any changes in health.

• Stay updated on vaccinations. Preventing and treating infections can help reduce the risk of sepsis. The provider will review the vaccination history and recommend boosters as needed.

• Attend postpartum visits. Pregnancy brings changes to the body, and it is essential to be aware of sepsis, even though it is rare so that one can advocate for oneself and their baby.

Conclusion

In summary, maternal sepsis is a serious condition ranking as the third leading cause of maternal death. Timely identification and treatment are essential during pregnancy, childbirth, or postpartum. Symptoms can be challenging to distinguish from normal pregnancy changes, underscoring the importance of early detection. Causes range from pregnancy-related infections to common bacterial or viral infections. Treatment involves prompt antibiotic administration, baby monitoring, and, in severe cases, ICU admission or surgery. Maternal sepsis poses risks to both mother and baby, impacting future pregnancies and potentially leading to lingering complications.