Maternal sepsis update: current management and controversies

Abstract

Key content Sepsis is a leading cause of maternal morbidity and mortality, globally and in the UK. In pregnancy and the puerperium, women may be more susceptible to rapid deterioration of illness following an infection. Sepsis has a complex pathophysiology and the immunological and cardiovascular adaptations of normal pregnancy may have an adverse impact on the maternal response to infection. Furthermore, physiological changes of pregnancy, which mimic those of sepsis, often delay recognition and optimal management. ‘Bedside’ identification of pathogens and their antibiotic resistance patterns may help to improve clinical outcomes. Recent updates in sepsis management, areas of controversy and the importance of translational research and clinical trials for pregnancy and the puerperium are discussed. Learning objectives To highlight the difficulties of diagnosing sepsis in pregnancy. To highlight recent updates, new definitions and controversies of current sepsis management. To highlight the potential for research to develop novel biomarkers and therapeutic agents specific to the pregnant woman. Ethical issues Sepsis research involving new technologies differentially benefits high‐income countries compared with low‐/middle‐income countries despite the greatest burden of maternal sepsis being in the latter. With the current rapid evolution of omic technology platforms, greater affordability will provide greater accessibility.