Rachel E. Bridwell, MD; Brandon M. Carius, MPAS, PA-C; Brit Long, MD; Joshua J. Oliver, MD; Gillian Schmitz, MD

Disclosures

Western J Emerg Med. 2019;20(5):822-832. 

In This Article

Abstract and Introduction

Abstract

The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.

Introduction

In the United States, sepsis is the fourth leading cause of maternal death.[1–3] Mortality in pregnant patients rose consistently at an average of 9% per year from 2001 to 2010 despite sepsis guidelines updates.[1,4,5] As sepsis occurs in only 0.001% of pregnancies and in 0.002–0.01% of postpartum patients, data and consensus are limited regarding diagnostic and therapeutic interventions.[4] Additionally, pregnancy is an exclusion criterion in all major sepsis trials to date, relinquishing clinical decisions to provider preference and expert opinion.[6–8]

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