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Although pregnancy is the same for women worldwide, their safety varies greatly depending on where the women live and the type of medical care they receive, if any.
Sepsis is an illness that can develop in some pregnant women, as well as in women who have recently delivered a baby or babies. Sepsis that occurs during pregnancy is called maternal sepsis. If it develops within six weeks of delivery, it is called postpartum sepsis or puerperal sepsis. Sometimes called blood poisoning, sepsis is the body’s often deadly inflammatory response to infection. Sepsis kills and disables millions, more than breast cancer, lung cancer, and stroke combined.
Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, and organ dysfunction (organs don’t work properly) and/or amputations.
Maternal and postpartum sepsis are more common in the developing countries, but they also do strike women in the wealthier countries, including in the United States. In the mid-90s, sepsis was responsible for about 7.6% of maternal deaths in the U.S. And while pregnancy-associated sepsis is not as common in American hospitals as it used to be decades ago, it is still potential deadly and requires early detection, accurate diagnosis, and aggressive treatment. In fact, a new study published in October 2013 reported that severe sepsis and sepsis-related deaths are actually rising in the U.S. The study also reports that “Sepsis is currently the leading cause of direct maternal death in the United Kingdom.”
How does sepsis occur in pregnant and postpartum women?
Sepsis can occur because of an infection related to the pregnancy or one that is totally unrelated, such as pneumonia or a urinary tract infection (UTI). An article published by the American College of Emergency Physicians in 2012, said that women with maternal sepsis can make up as many as 30% of pregnancy-related sepsis cases admitted to intensive care units in countries like the U.S. The authors found that the most common infections that triggered maternal sepsis were caused by bacteria such as E. coli.
Sepsis can develop as the result of many complications. Here are just a few:
- Miscarriages (spontaneous abortions) or induced abortions: Infections are a risk after any miscarriage or abortion. Non-sterile abortions,those that may be done outside of a healthcare facility, are a particular risk. Women who have had one should watch for signs and symptoms of an infection (lasting or increasing pain, discolored or odorous (smelly) discharge, abdominal tenderness, high temperature, fatigue, feeling unwell).
- Cesarean sections: Sepsis can set in after any type of surgery. Cesarean sections are major abdominal surgeries with all the associated risks. See Sepsis and Surgery for more information.
- Prolonged or obstructed labor: An unusually long time of labor or labor that stops progressing.
- Ruptured membranes: The longer the period between the “water breaking” and the baby’s birth, the higher the chance of an infection.
- Infection following vaginal delivery: Although not common in the developed world among women who give birth in healthcare facilities, infections are very common in the developing world.
- Mastitis: Infection in the breasts can trigger sepsis.
- Viral or Bacterial Illnesses: Any illness that raises the risk of sepsis in the general population will do so in pregnant women as well. For example, see: Sepsis and Influenza, Sepsis and HIV/AIDS and Sepsis and MRSA
Who is at risk?
Any woman who is pregnant, has miscarried or aborted, or who has delivered a child is at risk of developing maternal or postpartum sepsis. However, some women do have a higher risk than do others. This includes women who have a history of congestive heart failure, liver disease, or lupus, according to a report presented at the American Society of Anesthesiologists Meeting in 2012. Women under 25 years old and those who are obese also fall into this higher risk category.
Women who may be more prone to getting an infection, which can lead to sepsis, are those:
- With diabetes (see Sepsis and Diabetes)
- Who undergo invasive procedures to help them get pregnant
- Who undergo invasive tests during pregnancy
Although women under 25 are at risk, so are women over the age of 40 because they have a higher possibility of placenta previa (the placenta covers all or part of the cervix) and abruptio placenta (part of the placenta comes away from the uterus wall), which again increases infection risk.
Is sepsis hard to detect in pregnant or postpartum women?
Diagnosing sepsis in a pregnant woman or one who has recently given birth can be challenging. Pregnancy and delivery causes many changes in the body, including a faster heart beat, changes in blood pressure, and faster breathing. Usually, these are signs that may alert a healthcare provider that there may be something wrong, such as an infection. Also, many women get chills and sweat heavily after giving birth. They may also have pain, or feel dizzy or light headed.
It also may be more difficult to diagnose infections in pregnant and postpartum women. For example, urinary tract infections usually cause a frequent need to urinate, but this can happen because of pregnancy alone. So if a woman is going to the bathroom a lot, she may just chalk it up to being pregnant and not realize that she has an infection.