Maternal sepsis remains a leading cause of maternal mortality
The coroner said at conclusion of the inquest into Sarah Dunn's death that she was 'staggered' at the lack of awareness of maternal sepsis by medical practitioners, not least since it is the major cause for the admission of pregnant women into the intensive care unit.
Maternal sepsis is a life-threatening condition with organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or in the postpartum period. Treated quickly and effectively, the disease can be stopped in its tracks. Unfortunately, left untreated it can be fatal for mother and baby.
The obstetric causes of maternal sepsis include uterine infection, septic abortion, and wound infection. The non-obstetric causes include pyelonephritis and pneumonia. Maternal sepsis can result from invasive procedures such as amniocentesis, chorionic villus sampling, cervical cerclage, or percutaneous umbilical blood sampling. Sepsis is a medical emergency and needs urgent review from a senior clinical decision maker.
NICE guidelines recommend that all service providers (NHS hospital trusts) ensure that protocols, systems and pathways are in place for pregnant women in labour with sepsis to have an immediate review by a senior clinical decision maker and receive the first dose of antibiotics, if indicated, within a 1-hour timeframe. They also ensure that a senior clinical decision maker is available to perform the review and protocols are in place to document the rationale for the decision to start antibiotics.
A recent study published on the online medical review, Maternal Fetal Medicine, highlights that is imperative to stabilise the mother first, after which the baby's status will also improve. The decision of whether to deliver the baby or to continue the pregnancy is influenced by several factors, including the patient's condition, the gestational age of the foetus, the fetal condition, the presence of chorioamnionitis and the stage of labour.
The study also suggests that efforts should be aimed at treating maternal sepsis and prolonging pregnancies that are far from term if the source of infection is outside the uterus, but if the source of sepsis is from the uterus, 'delivery of the fetus is required'. In any case, the "Hour-1 bundle" is essential since the early use of appropriate antibiotics is crucial to managing maternal sepsis.
In many cases, maternal sepsis gives rise to litigation, based on the failure to recognise sepsis and to instigate appropriate investigation; delayed treatment; incomplete treatment; failure to consider urgent delivery; failure to isolate the source of infection; failure to involve senior clinicians at an early stage; failure to utilise a multidisciplinary team early on; delay in recognising failed treatment and failure to transfer to the critical care setting.
Equally, delays in treating maternal sepsis can lead to significant morbidity. In a previous case, a mother suffered a cervical tear during delivery and infection with Group B Streptococcus (which is often present in the vaginal tract) entered the blood stream and caused pelvic sepsis. She was discharged from hospital despite signs of infection and being unable to weight bear and walk. Due to delays in diagnosis and starting antibiotics this lady ended up in a critical condition in ITU with septicaemia and multi-organ failure. The infection also caused damage to her joints due to reactive arthritis and as a result of postpartum sepsis she was left with serious mobility problems, she was unable to return to work and had difficulty caring for her children.
Sarah Dunn's mother was brave enough to speak out on ITV News about the failings in care that contributed to her daughter's death. Let's hope it does not take another death from maternal sepsis to bring home how important understanding and treatment of the disease is to keep women safe.
Find out more about sepsis claims.