How to spot maternal sepsis

What is sepsis?

Sepsis is a complication of a severe infection. When the immune system fights the infection, sepsis sees the body go too far and start to attack organs and other tissues.

When it occurs in pregnant women or within six weeks after giving birth, it’s called maternal or postpartum sepsis (Bonet et al, 2017). Without quick treatment, sepsis can lead to multiple organ failure and death. It is the third most common cause of maternal death in the first six weeks after birth in women in the UK and Ireland (MBRRACE-UK, 2021).

What are the signs and symptoms of sepsis?

If you start to develop any of these symptoms, you or your family should seek medical advice from NHS 111 or go to a maternity unit quickly (MBRRACE-UK, 2021). Symptoms of sepsis may be less obvious in a pregnant woman and may progress quicker than for a non-pregnant woman (RCOG, 2012a). If your symptoms are severe, go straight to A&E or call 999 (NHS Inform, 2022).

Signs and symptoms to look out for:

• High temperature or fever over 38°C.  
• Low body temperature.
• Fast heartbeat.
• Chills and shivering.
• Severe muscle, abdominal or chest pain.
• Feeling dizzy or faint.
• Diarrhoea, nausea or vomiting.
• Abnormal or unpleasant vaginal discharge.
• Productive cough.
• Symptoms of a urinary tract infection.
• Acting confused or slurring speech.
• Skin feels cold or clammy. 
• Skin can be paler than normal, or mottled with lighter patches on dark skin, or with red on light skin.
• A rash that does not fade when you roll a glass over it (similar to meningitis).
• Difficulty breathing, breathlessness or breathing very fast.
• Loss of consciousness.

(RCOG, 2012a,b; NHS, 2019; NHS Inform, 2022)

What causes sepsis?

Sepsis can be triggered by an infection in the body. Normally, the body responds by sending white blood cells to that area to kill the germs that are causing the infection. This makes the tissue swell (inflammation), which helps to stop the spread of the infection. If the infection travels to other parts of the body, there can be widespread inflammation. This can damage tissues, reduce blood pressure and prevent oxygen reaching organs and tissues (NHS Inform, 2022).

It’s impossible to know who will suffer from sepsis until it happens but risk factors for maternal and postpartum sepsis can be:

• Having recently had surgery.
• Having a medical condition that weakens the immune system.
• Prolonged length of time between waters breaking and the baby being born.
• Diabetes.
• Anaemia.
• History of pelvic infection.
• History of group B streptococcal infection.
• Streptococcal infection in close contacts or family members.
• Obesity.
• Black or other minority ethnic group origin.
• (RCOG, 2012a,b; NHS Inform, 2022)

To reduce the chance of infection after birth, focus on good hygiene practices. Washing hands before and after changing a sanitary pad or touching the perineum will help prevent infections from occurring, as will avoiding close contact with people who have a sore throat or upper respiratory tract infection (RCOG, 2012b).

How is sepsis diagnosed?

If there is concern that someone has sepsis, they will be treated with antibiotics very quickly. Sepsis may be diagnosed through a blood test and from monitoring temperature, heart and breathing rates (RCOG, 2012b; NHS Inform, 2022).

Further tests can uncover what type of sepsis it is, where it’s located and which bodily functions have been affected. Tests can include a blood test, urine or stool samples, a vaginal or throat swab, wound culture, X-ray and a number of other tests (RCOG, 2012b; NHS Inform, 2022).

What is the treatment for sepsis?

Severe sepsis or septic shock is a medical emergency. If sepsis is detected early and hasn’t affected vital organs, it may be possible to treat the infection with antibiotics, leading to a full recovery. Antibiotics may be started before the cause of the infection is known so as not to delay treatment (NHS, 2019; NHS Inform, 2022).

Treatment will vary depending on the site and cause of the initial infection, the organs affected and the extent of any damage.

After hospital admission, treatment should be started by a medical team within an hour of diagnosis. It may involve:

• Giving antibiotics to fight the source of the infection.
• Giving fluids intravenously for the first 24 to 48 hours.
• Inserting a catheter to monitor urine production to check kidney function.
• Giving oxygen by a mask or tube if levels are low.
• Giving medication to increase blood pressure if it has dropped.

(NHS, 2019; NHS Inform, 2022)

Some people may also be offered steroids, insulin medication, a blood transfusion, mechanical ventilation or kidney dialysis if needed. This would generally take place in the intensive care unit of a hospital (NHS, 2019; NHS Inform, 2022).

Can maternal sepsis affect the birth or baby?

If a pregnant woman is ill with sepsis, then bringing forward the birth of the baby may be considered (RCOG, 2012a). If it is likely that a baby would need to be born early, the mother would receive steroid injections to prepare the baby’s lungs for birth.

Epidural or spinal anaesthesia would not be recommended so a general anaesthetic would be used in the case of a caesarean birth. There would be continuous monitoring of the baby’s heart rate and the mother’s temperature during the birth (RCOG, 2012a).

The infection which caused the sepsis could pass from the mother to the child before, during or after the birth, which is why there is additional monitoring for the baby during the birth (RCOG, 2012a). Depending on the type of infection, antibiotics may be offered to the baby after birth to prevent them catching the infection (RCOG, 2012a).

Is sepsis the same as septicaemia and blood poisoning?

Not quite but the terms are sometimes used interchangeably (NHS, 2019). Neither term is entirely accurate because septicaemia (blood poisoning) refers to invasion of bacteria into the bloodstream. This infection can trigger sepsis (Meningitis Research Foundation, 2019).

Sepsis is not just limited to the blood and can affect the whole body, including the organs. Sepsis can also be caused by viral or fungal infections, although bacterial infections are by far the most common cause (NHS, 2019).

This page was last reviewed in July 2022.

Further information

Our support line offers practical and emotional support with feeding your baby: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

You might find attending one of our NCT New Baby groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

If sepsis has affected you or someone close to you, you can contact the UK Sepsis Trust.