Sepsis in obstetrics

Abstract

### Key points Sepsis was the leading cause of direct maternal deaths in the 2006–8 triennium report of the Centre for Maternal and Child Enquiries UK (CMACE).1 Eighty-three women died from sepsis during the period 2009–2012. Although overall maternal mortality has declined impressively as a result of implementing policies based on the recommendations of CMACE, the number of deaths from sepsis has risen and fallen again perhaps as a consequence of national initiatives but perhaps because of changes in patterns of disease.2 This article is focused on the contribution of obstetric anaesthetists to the early recognition and management of the septic obstetric patients based on the most recent evidence available. The report for 2006–2008 highlighted the role of genital tract sepsis (29 deaths) whereas the 2009–2012 report highlighted the deaths of 36 women from influenza, nearly all form the H1N1 variant. Genital tract sepsis from community acquired beta-haemolytic streptococcus, Lancefield Group A– Streptococcus pyogenes (GAS) occurred in 13 of the 29 deaths and in 12 of the 20 deaths in 2009–2012. Analysis of the survivors of septic shock in pregnancy reported that 24 of the 34 women had genital tract infection. ### Sepsis Sepsis is broadly understood to exist when an infectious process has triggered the systemic inflammatory response syndrome (SIRS). SIRS is an inflammatory response to physiological insult which is characterized by the presence of: