Sepsis in Pregnancy: Causes, Warning Signs, and Treatment

In short: Sepsis is a serious infection that reaches the blood and affects the body’s systems, and can lead to failure of several organs. Risk factors include diabetes, membranes ruptured for a long time, surgery and foul-smelling discharge. Symptoms include fever, confusion and extreme tiredness. It needs immediate treatment with intravenous antibiotics and fluids, and may require intensive care or early delivery.

Sepsis is a life-threatening reaction of the body to an infection, in which the body’s response starts to damage its own organs. It can start from an infection anywhere, such as the urine, the womb or the chest, and needs emergency treatment. While it is uncommon, understanding the warning signs can help expectant mothers seek timely care.

During pregnancy, a woman’s immune system naturally adapts to support her growing baby, which can also make her more vulnerable to infections. This is why recognizing the risk factors and symptoms of sepsis is especially important during this time.

Factors in pregnancy that increase the risk of sepsis:

• diabetes
• prolonged rupture of membranes
• invasive procedures
• recurrent vaginal bleeding
• foul smelling vaginal discharge
• natural changes in the immune system during pregnancy, which make some infections more serious
• obesity, anaemia, and close contact with someone who has a streptococcal (strep) throat infection, such as a young child at home

How Doctors Assess Suspected Sepsis in Pregnancy

• history taking focusing on recent contact with sick individuals
• physical examination looking for: skin rash, cyanosis, breach of skin integrity and looking for sources of infection that might need drainage
• vital signs: temperature, pulse rate, oxygen saturation, blood pressure
• blood tests
• imaging of body cavities looking for a source of infection that needs surgical intervention

Note that alteration of mental status is a red flag in sepsis.

Blood tests to be done in sepsis:

• blood gas, including glucose and lactate measurement
• blood culture
• full blood count
• C-reactive protein (CRP)
• urea and electrolytes
• Creatinine
• liver function tests
• a clotting screen

How Sepsis Is Managed During Pregnancy

• broad spectrum IV antibiotics given within one hour of suspecting sepsis (after blood cultures are taken, without delaying treatment)
• IV fluids to maintain good tissue perfusion
• Admission to a high-dependency or intensive care unit if the sepsis is severe or organs are affected
• Multidisciplinary care
• Close observation of vital signs
• Vasopressors if in shock
• Daily blood tests

Note that the antibiotic can be changed according to the culture results.

What is the target oxygen saturation?

94-98%

Does sepsis need early delivery or termination of pregnancy?

• early delivery can be considered if the maternal condition is deteriorating in order to save the fetus if viable
• early delivery can be considered if the infection was inside the uterus
• termination of pregnancy can be considered if the source of infection is the pregnancy tissue

If you have concerns about infection during pregnancy or would like to discuss your care with an experienced specialist, the team at Dr. Najeeb Layyous’s clinic is here to help guide you through a safe and closely monitored pregnancy.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist