How to avoid sepsis in pregnancy

By Brenna McGuire, MD | May 27, 2022

Especially during pregnancy, knowledge is power. Sometimes that means learning about fun things, like how big your baby will be at each stage of pregnancy. But sometimes, it means learning about scary things, like getting very sick while you are pregnant.

One scary illness you may hear about is maternal sepsis. Sepsis is a rare and extreme inflammatory reaction to a severe infection. If sepsis develops during pregnancy or after birth, it’s called maternal sepsis and it can become a life-threatening condition.

An existing infection—like a respiratory illness or urinary tract infection—can trigger a chain reaction in your body and lead to something more serious like strep and sepsis.

Your odds of maternal sepsis increase if you have

• Prolonged labor
• A cesarean delivery (C-section)
• Mastitis—infected milk ducts in the breast
• Placenta fragments that stayed in your body after delivery
• Poor hand hygiene
• Exposure to someone with a respiratory illness

According to the Centers for Disease Control and Prevention (CDC), maternal sepsis is the second leading cause of pregnancy-related deaths. However, it is rare, occurring in just 0.04% of deliveries. The World Health Organization (WHO) reports that maternal sepsis can be diagnosed up to 42 days after giving birth.

My point is not to scare you, but to empower you. It’s important to know the symptoms of sepsis and how to reduce your risk. The faster you or your prenatal care provider spot the signs of sepsis, the faster we can get you help—and potentially save your life.

Symptoms of Maternal Sepsis

Recognizing maternal sepsis can be difficult. Many sepsis symptoms are the same as regular pregnancy changes, particularly for women in labor.

Early diagnosis for sepsis is critical. Time matters. If you experience any of these symptoms during your pregnancy—or after discharge from the hospital—call your doctor or midwife immediately:

• Fever and chills
• Extremely low body temperature
• Foul-smelling vaginal discharge or bleeding
• Rapid heartbeat
• Dizziness
• Decreased urine output
• Fatigue
• Blotchy or discolored skin

When you’re in the hospital to deliver your baby, we’ll check your vitals, order blood work, and monitor your health. UNM Hospital providers are experts at recognizing the warning signs and symptoms of maternal sepsis. However, it’s important that you also know the warning signs so you can talk with your doctor or midwife.

How Is Sepsis Treated?

Women with maternal sepsis need to stay in the hospital. You will get IV antibiotics to fight the infection. Your care team will check your blood pressure and organs to try to prevent long-term injury. Treatment may include giving options such as giving you fluids, performing a blood transfusion, or giving you medication to control your blood pressure.

Reducing Your Risk

While there is no way to prevent every illness that could turn into sepsis, you can take steps to reduce your risk. Start with these steps and ask your doctor or midwife if there is anything special you should do based on your personal health needs:

1. Schedule prenatal care. Our caring staff uses simple exams and tests to monitor your pregnancy. When you attend these regular appointments, we can also quickly assess any health concerns you have.
2. Call us with any concerns. You know your body. If you feel “off,” we want to see you as soon as possible.
3. Manage conditions like diabetes. Inform your care team if you notice any health changes.
4. Stay up to date on your vaccinations. Preventing and treating infections can reduce your risk of sepsis. Your provider will review your current list and make recommendations on boosters.
5. Attend postpartum visits. Having a baby changes your body. Our compassionate team will answer questions, provide resources, and assess your overall health.

Remember that sepsis is a rare condition, but it’s important you know about it so you can advocate for yourself and your baby.

Sepsis is a life-threatening condition in which the body systemically responds to an infection. Although relatively rare, sepsis during pregnancy is one of the leading causes of death in mothers and complications for the fetus.

Treatment can be difficult, given the presence of the fetus, and so litigation in relation to sepsis centers on prevention of infection, early identification and treatment support.

Image Credit: Virojt Changyencham / Shutterstock

Incidence

Sepsis during pregnancy is a relatively rare condition, yet still a significant cause of mortality. Like most kinds of sepsis, sepsis during pregnancy is on the rise due to increased age of mothers.

Sepsis-related mortality in mothers has increased from 0.81 per 100,000 pregnant women in 2003-2005 to 1.13 per 100,000 in 2006-2008. More women are giving birth over the age of 40, which means they are more likely to have chronic health conditions such as diabetes and obesity. Such chronic health conditions, or comorbidities, are significant risk factors for developing sepsis.

While fantastic, new technologies such as artificial insemination and fetal medicine do increase the occurrence of high risk pregnancies. This is also believed to underlie the rise in sepsis during pregnancy. Septic shock can also occur after delivery, although it is very uncommon at around 0.002% to 0.01% of the time.

Sepsis is one of the top causes of mortality in pregnancies, together with hemorrhage, hypertensive disease and abortion.

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Certain infections are more common in pregnant women and can be the starting point for the pathogen infection which triggers sepsis. Urinary tract infections (UTIs) is common during pregnancy due to a reduction in the kidney’s concentrating ability. This leads to the presence of bacteria in the urine, called bacteriuria. The ureteral dilation during pregnancy then allows for ascending infections, predisposing up to 40% of pregnant women to inflammation in the kidneys because of this. Sepsis with a source in the urinary tract is often treated with antimicrobials. However, antimicrobial resistance is rising in urinary tract infection pathogens, making it a serious issue that is hard to treat.

Bacterial pneumonia is a common source of sepsis and is likewise so in pregnant women. Influenza and varicella are potential causes of rapidly progressive viral pneumonia in pregnant women, with the emergence of H1N1 influenza (swine flu) making pregnant women vulnerable to severe pneumonia.

This was particularly true if afflicted with any of the aforementioned comorbidities. Here, where the source of the infection is viral and not bacterial, antiviral medication and infection control parameters are used to stop spread and hopefully curb the onset of sepsis.

Treatment

Treatments typically follow standard sepsis treatment, wherein re-establishing good levels of tissue perfusion is one of the early steps. The fluids used in resuscitation are debated, but in general pregnancy is not a condition that necessitates the withholding of vasopressors or inotropic agents which are usually supplied. On the other hand, dopamine and norepinephrine can be deceptive as they can improve the maternal state while damaging blood flow to the placenta and uterus. This would be in addition to the altered balance between fetal oxygen supply and consumption that can be altered when the mother develops sepsis.

Sepsis can lead to pulmonary edema due to increased permeability of the vascular system in the body. This may facilitate the need for invasive mechanical ventilation. Invasive mechanical ventilation is used in conjunction with sedative and/or neuromuscular blocking agents, which are also capable of crossing the placenta. They can then cause a reduction in fetal heart rate variability and fetal movements, which obstructs proper monitoring of the fetus and its health.

When sepsis is detected, blood cultures are taken and examined so that appropriate antibiotics can be administered as soon as possible. In pregnant women with sepsis, the sepsis is often caused by several pathogens, which necessitates the use of broad spectrum antibiotic therapy. However, several antibiotics have modified pharmacological properties in pregnant women. This includes greater distribution volume and changes in absorption and excretion. In the end, the serum drug levels are reduced, especially by antibiotics excreted in urine. In addition to that, certain antibiotics are unsafe for the fetus and therefore need to be avoided.

Professionals in the field are also looking to prevent sepsis complications in pregnant women before treatment becomes necessary. Excessive blood coagulation is induced by both pregnancy and sepsis. This means that preventing blood clots inside vessels, otherwise known as thrombosis, is critical. Compression socks, intermittent lower limb compression and blood thinning medication in addition to stimulation of early walking are often used to prevent thrombosis.

Sources

Last updated Sep 9, 2018