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SOGC Infectious Diseases Committee Statement on Maternal Sepsis

Sepsis is the third most common direct cause of maternal mortality. Globally, it is estimated that sepsis causes up to 75,000 maternal deaths each year (WHO). In high income countries, maternal sepsis related deaths approach 1.8/100,000 pregnancies (BMJ Open 2016; 6: e012323) with an incidence of maternal morbidity due to sepsis of 0.1-0.6 / 1000 deliveries (PloS Med 2014; 11:e1001672). It is also highly preventable and deaths due to sepsis can be prevented if treated early. 

Unfortunately, rates of maternal sepsis are on the rise, globally and in high income countries, although the reason is unclear. (Plos One 2013;8(7):e67175.) However, an increase in the number of infections associated with virulent organisms such as group A Streptococcus, highlights the urgency of the need for the early detection of sepsis, and rapid therapeutic response (Current Opinion in Obstetrics and Gynecology 2013 April;25(2): 109-16.)  A recent Ontario Coroners report highlighted two cases of maternal death due to sepsis. Critical to their review was the finding that incomplete recognition of the signs and symptoms of sepsis led to delayed treatment, resulting in catastrophic outcomes.  

Maternal sepsis has been defined by the World Health Organization as a life-threatening condition, whereby there is organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or the post-partum period. Criteria for the identification of maternal sepsis cases should be based on the presence of suspected or confirmed infection, plus signs of mild to moderate organ dysfunction including tachycardia, hypotension, tachypnea, altered mental status and/or reduced urinary output. (WHO reference number: WHO/RHR/17.02). Successful management of sepsis requires a high index of suspicion, rapid identification of at risk patients and appropriate treatment, including antibiotic or antiviral therapy, fluid resuscitation and intensive monitoring. 

Unfortunately, the physiologic changes of pregnancy make the diagnosis of maternal sepsis challenging. However, its early recognition and rapid initiation of therapy is critical. If detected early, treatment of sepsis can prevent both maternal morbidity and mortality. Every health care facility should be aware of the signs and symptoms of sepsis and have systems in place to provide prompt and aggressive treatment. The SOGC encourages each health care facility to discuss their approach to the detection and management of sepsis. To assist with this, a task force is being struck by the SOGC to review the current literature available on bedside tools that assist in the identification of maternal sepsis, identification of at risk patients and appropriate treatment algorithms and pathways.