1. Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN

Article Content

Sepsis in pregnancy and postpartum has increased over the past decade (Kendle, Salemi, Tanner, & Louis, 2019) and is one of the major causes of maternal death in the United States (Centers for Disease Control and Prevention, 2018). Kendle et al. studied more than 55 million hospital births from the National Inpatient Sample from 2002 to 2015 and found that the rate of sepsis increased each year, to a high of 3.7 per 10,000 births in 2015. They identified women more likely to develop sepsis; those covered by Medicaid, 40 years or older, and Black. As we know based on evaluation of maternal mortality in the United States, racism rather than race is the risk factor that predisposes Black women to worse outcomes than Caucasian women (Howell et al., 2019). Obstetric etiologies of infection are chorioamnionitis, wound infection, endometritis, and septic abortion, whereas nonobstetric causes are urinary tract infections, pneumonia, appendicitis, and gastrointestinal infections (Society for Maternal-Fetal Medicine [SMFM], Plante, Pacheco, & Louis, 2019).


In April 2019, SMFM published helpful clinical guidelines for caring for women with sepsis during pregnancy and postpartum. Included is a review of most recent evidence, definitions, a sequential organ failure scoring tool, a list of specific recommendations, and a treatment algorithm. Initial management, fluid therapy, medications such as antibiotics, vasopressors, and inotropes, and timing of birth based on maternal and fetal status are covered (SMFM et al., 2019). They highlight importance of accurate and timely identification of sepsis followed by prompt treatment, recommending that sepsis and septic shock be considered medical emergencies requiring immediate intervention (SMFM et al.). Careful review of this resource is recommended.


In 2017, we offered a special topics series on sepsis in obstetrics in the July-August issue of MCN. The articles provide valuable information and together they are an excellent resource on sepsis for maternity nurses (Parfitt, Bogat, Hering, Ottley, & Roth, 2017; Parfitt, Bogat, Hering, & Roth, 2017; Parfitt, Bogat, & Roth, 2017). Pathophysiology, diagnostic definitions, clinical features, early warning tools, treatment, prognosis, and prevention are presented. Guest editor Cheryl Roth and her team obtained permission from a woman who developed sepsis during pregnancy, to discuss her experience and clinical sequelae (Parfitt, Bogat, Hering, et al.). The details offer a real-life view of the significant implications for some survivors of sepsis in pregnancy.


As there has been more focus on causes and prevention of maternal mortality in the United States, these resources are suggested to help nurses access latest information on predisposing factors, causes, signs, symptoms, and treatment for sepsis in pregnancy and postpartum. Working together as part of an interdisciplinary team requires that all members of the team have knowledge of the most recent clinical guidelines and the ability to apply them to clinical practice.




Centers for Disease Control and Prevention. (2018). Pregnancy mortality surveillance system (Reproductive Health). Atlanta, GA: Author. Retrieved from[Context Link]


Howell E. A., Brown H., Brumley J., Bryant A. S., Caughey A. B., Cornell A. M., ..., Grobman W. A. (2019). Reduction of peripartum racial and ethnic disparities: A conceptual framework and maternal safety consensus bundle (Consensus Statement). Obstetrics and Gynecology, 131(5), 770-782. doi:10.1097/AOG.0000000000002475 [Context Link]


Kendle A. M., Salemi J. L., Tanner J. P., Louis J. M. (2019). Delivery-associated sepsis: Trends in prevalence and mortality. American Journal of Obstetrics and Gynecology, 220(4), 391.e1-391.e16. doi:10.1016/j.ajog.2019.02.002 [Context Link]


Parfitt S. E., Bogat M. L., Hering S. L., Ottley C., Roth C. (2017). Sepsis in obstetrics: Clinical features and early warning tools. MCN. The American Journal of Maternal Child Nursing, 42(4), 199-205. doi:10.1097/NMC.0000000000000340 [Context Link]


Parfitt S. E., Bogat M. L., Hering S. L., Roth C. (2017). Sepsis in obstetrics: Pathophysiology and diagnostic definitions. MCN. The American Journal of Maternal Child Nursing, 42(4), 194-198. doi:10.1097/NMC.0000000000000339 [Context Link]


Parfitt S. E., Bogat M. L., Roth C. (2017). Sepsis in obstetrics: Treatment, prognosis, and prevention. MCN. The American Journal of Maternal Child Nursing, 42(4), 206-209. doi:10.1097/NMC.0000000000000341 [Context Link]


Plante L. A., Pacheco L. D., Louis J. MSociety for Maternal-Fetal Medicine. (2019). Sepsis during pregnancy and the puerperium (SMFM Consult Series #47). American Journal of Obstetrics and Gynecology, 220(4), B2-B10. doi:10.1016/j.ajog.2019.01.216 [Context Link]