How to spot post-natal sepsis, the most common cause of maternal death
Sepsis is a severe complication of an infection, occurring when the body’s immune system attacks organs and other tissues in the body. When it appears in pregnant women or within six weeks of giving birth, it is called maternal or postpartum sepsis. It is important that maternal sepsis is treated promptly and appropriately, as sepsis can lead to multi organ failure and even death.
Sadly, maternal sepsis is a leading cause of maternal death in the UK. In December 2020 a report found that in the period from 2016-2018, 31 women died from maternal sepsis in the UK and Ireland.
Maternal sepsis can be caused directly by infections of the genital tract or a wound infection after giving birth, or indirectly through infections such as flu or meningitis.
I spoke recently with Professor Dimitrios Siassakos, an Honorary Consultant in Obstetrics at University College Hospital. He is an expert in the management of obstetric emergencies, including the diagnosis and management of sepsis.
During our discussion, Professor Siassakos set out the early warning symptoms of sepsis that all post-natal women should be made aware of and the steps that should be taken.
Thanks for joining us Prof. Siassakos. Can you tell us, what are the early warning symptoms of sepsis?
Symptoms and signs of maternal sepsis can be less obvious in post-natal women than in the general population. Medical professionals should therefore be highly suspicious of infection and sepsis if a woman is experiencing a high temperature, pain and tenderness that is not relieved with usual pain relief medication, or is “feeling unwell” after giving birth. Women exhibiting these symptoms should be referred hospital to for prompt medical review.
More specifically, the clinical signs suggestive of sepsis include one or more of the following:
- Hypothermia (low temperature)
- Tachycardia (a heart rate of over 90 beats per minute)
- Tachypnoea (abnormally rapid breathing)
- Hypoxia (low oxygen levels in the blood)
- Low blood pressure
- Oliguria (peeing less than usual)
- Impaired consciousness
- Failure to respond to treatment.
These signs, including fever, may not always be present and are not necessarily related to the severity of sepsis.
If sepsis is suspected though once you have been discharged from hospital, an urgent referral back to hospital for assessment is required. If you experience any of the following ‘red flag’ symptoms for sepsis, you should be referred to hospital as a matter of urgency:
- A temperature of more than 38 ºc
- Heart rate persistently over 100 beats per minute
- Breathlessness (respiratory rate of over 20 breaths per minute)
- Abdominal (tummy) or chest pain
- Diarrhoea and/or vomiting.
All medical professionals such as community midwives and general practitioners should be aware of the significance of these red flag symptoms and of the importance of diagnosing and treating sepsis properly.
If these symptoms are present, how is sepsis diagnosed?
If doctors are concerned that you may have sepsis, you will undergo blood tests.
Further tests such as urine or stool samples, swabs from the vagina, and cultures from any wound (for example caesarean incision or perineal tears) may also be taken.
And if the diagnosis of sepsis is confirmed, what is the treatment?
If infection is detected early and hasn’t affected vital organs, it may be possible to treat it at home with antibiotics.
Unfortunately, sepsis is often not diagnosed until hospital treatment is necessary. In cases of severe sepsis, treatment involving the “Sepsis Six” should be started within an hour of diagnosis.
The “Sepsis Six” involves:
• Giving oxygen if levels are low
• Blood cultures to identify the type of bacteria causing the infection/sepsis
• Giving IV antibiotics
• Giving intravenous (IV) fluids
• Blood sample to assess the severity of the sepsis
• Measuring urine output-to assess kidney function.
Thank you to Prof. Siassakos for offering his insight into maternal sepsis.
As a solicitor specialising in clinical negligence, I also often meet mothers who have been injured during pregnancy, childbirth or in the immediate post-natal period. I have also represented mothers who, despite all of the warnings regarding the importance of recognising maternal sepsis, have suffered from life changing injuries, including hysterectomy and early menopause, as a result of a delay in diagnosing and treating maternal sepsis.
A common theme that we have noticed in these cases is a tendency by medical professionals to ignore the clear guidelines and to repeatedly explain away symptoms of infection or sepsis. For example, an increased heart rate is because “the patient walked up the stairs”; abdominal pains are dismissed as “after pains”; considerable pain and swelling of the perineum is dismissed as “normal”, and feeling feverish is explained away as due to “milk coming in”. All of these examples are taken from real cases in which mothers have experienced serious harm after a misdiagnosis of sepsis.
Despite several national campaigns aimed at increasing awareness of sepsis amongst healthcare providers, it remains the one of the leading causes of maternal death in the UK. It is imperative that medical professionals properly recognise when a woman is unwell after giving birth, and if they are unsure of the cause of her symptoms, it is equally important that she is referred urgently for specialist input.