Sepsis in Pregnancy: Exploring Recent Advances in Diagnosis and Management

Obstetric sepsis is a major contributor to mortality rates in the United States and poses a significant public health issue. Notably, greater than 50% of these deaths could be prevented with timely and effective medical intervention. Diagnosing sepsis in pregnancy and the postpartum period is particularly challenging due to unique factors affecting this population, including the presence of physiologic changes in pregnancy that can obscure the presentation of sepsis. This review highlights the significance of early detection and intervention in obstetric sepsis. Increased awareness among healthcare professionals regarding differences in sepsis presentation among pregnant patients is important for early identification to reduce overall associated morbidity and mortality. This paper also reviews the most recent recommendations for the proper initial management of these patients once diagnosed.

The clinical presentation of obstetric sepsis differs significantly from that in non-pregnant patients, making the screening of these patients particularly challenging. There continues to be a lack of data regarding optimal screening tools for obstetric sepsis, and a high index of suspicion is necessary. Resuscitation with balanced fluids using dynamic hemodynamic indicators of fluid responsiveness is a critical part of early management. Norepinephrine remains the first-line vasopressor in pregnant patients, with vasopressin as a second-line. Steroids may be considered as adjunctive therapy for hypotensive patients with inadequate response to vasopressors. Early initiation of broad-spectrum antibiotics is critical, which can then be tailored to a suspected source. Source control is a key component of management, especially in patients with septic abortion.

Recognition and treatment of obstetric sepsis are critical in improving maternal and neonatal outcomes. A high clinical suspicion, thorough work-up, and rapid initiation of evidence-based management techniques are critical in these patients. Further research is required into obstetric-specific sepsis screening tools, pregnancy-specific mean arterial pressure goals to guide vasopressor titration, sepsis-specific biomarkers in antepartum and postpartum patients, and optimal steroid regimens for vasopressor-refractory hypotension.