Pregnancy & Childbirth

Although pregnancy is the same for people worldwide, their safety varies greatly depending on where they live and the type of medical care they receive, if any.

Sepsis is an illness that can develop during pregnancy, as well as after delivery. 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 incorrectly called blood poisoning, sepsis is the body’s life-threatening inflammatory response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. 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, 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 people in wealthier countries, including in the United States. According to the Centers for Disease Control and Prevention, sepsis is the second leading cause of pregnancy-related deaths. Between 2014 and 2017 infection or sepsis caused 12.7% of pregnancy-related deaths in the United States. Pregnancy-associated sepsis requires early detection, accurate diagnosis, and aggressive treatment. In the United Kingdom, a 2019 study found that sepsis accounted for as many as 25% of all maternal deaths in that country.

 

How does sepsis occur in pregnancy and after childbirth?

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). A recent analysis of delivery hospitalizations and postpartum readmissions in the U.S. found that 23% of in-hospital deaths were related to sepsis. The most common infections that triggered maternal sepsis were caused by bacteria such as E. coli, but those who are pregnant are also at higher risk of complications from COVID-19.

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. Anyone who has 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 develop 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 those 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 during pregnancy as well.

Who is at risk?

Anyone who is pregnant, has miscarried or aborted, or who has delivered a child is at risk of developing maternal or postpartum sepsis. However, some do have a higher risk others. Risk factors associated with developing maternal sepsis include not having given birth before (medically called nulliparity), and having public or no health insurance. Other childbirth-related risk factors include having a C-section, using assisted reproductive technologies in order to become pregnant, and having multiple births (twins, triplets, or more).

Those who may be more prone to getting an infection, which can lead to sepsis, are people:

  • With diabetes
  • Who undergo invasive procedures to help them get pregnant
  • Who undergo invasive tests during pregnancy

Being Black (due to racial disparities in US healthcare) also increases the risk of sepsis during pregnancy.

Are vaccines during pregnancy a good idea?

The CDC recommends that people be up-to-date on their vaccines before becoming pregnant, if possible. Speak with your doctor about your immunity to the so-called childhood diseases and if you need booster shots. People are also encouraged to get the seasonal flu vaccine even when pregnant. If you travel, you may need vaccines specific to your destination. Learn more about vaccines at Prevention: Vaccines.

Is sepsis hard to detect during pregnancy or the postpartum period?

Diagnosing sepsis during pregnancy or after recently given birth can be challenging. Pregnancy and delivery cause 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 people 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 during pregnancy and the postpartum period. For example, urinary tract infections usually cause a frequent need to urinate, but this can happen because of pregnancy alone. So if someone is going to the bathroom a lot, they may just chalk it up to being pregnant and not realize there may be an infection.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.” 

The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Suggested Citation: Sepsis Alliance. Sepsis and Pregnancy & Childbirth. 2022. https://www.sepsis.org/sepsisand/pregnancy-childbirth/

Updated March 8, 2022.

Maternal Sepsis Week

Join Sepsis Alliance for Maternal Sepsis Week, the week of Mother’s Day, to raise awareness of maternal sepsis, honor survivors, and remember those who have passed.

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Resources

Sepsis: Pregnancy and Childbirth
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Amanda’s Story – Maternal Sepsis
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Kayleigh’s Story – Maternal Sepsis
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Maile’s Story – Maternal Sepsis
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SEPSIS “Pregnancy and Childbirth” – PSA (0:23)
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SEPSIS “Pregnancy and Childbirth” – PSA (0:23)

SEPSIS “Pregnancy and Childbirth” – Español PSA (0:55)
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SEPSIS “Pregnancy and Childbirth” – Español PSA (0:55)

Faces of Maternal Sepsis

Jess Livett

After giving birth to my daughter via emergency c-section I got an infection in my womb but the midwifes and doctors failed to treat the infection and sent me home when my crp levels where 391. (Sepsis and Pregnancy & Childbirth) I then had to call an ambulance to my home as I couldn’t move, shivering and felt very out of the room. Got sent back to hospital where the infection had worsened and was told I had sepsis. I was on many many antibiotics as nothing was touching it after 7-8 weeks of antibiotics my levels went back to ... Read Full Story

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Cortina Pride

March 8th 2021, my water broke at 15 weeks 6 days. I had a cerclage in place due to an incompetent cervix and prior second trimester losses. On March 9th while still in the hospital, they were unable to detect my baby’s heartbeat via Doppler or ultrasound. She had passed away inside of me. Before I knew my baby had died, my body became very cold. I was shivering and couldn’t get warm even under three blankets. I knew something was wrong. I told the nurse that I didn’t feel right and I needed my doctor. My temperature had also ... Read Full Story

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Amelia H.

I don’t know how it happened. On Wednesday my husband and I had seen our 13w + 2d baby on the ultrasound screen. We were so excited for our second child! Thursday, I started bleeding and abdominal pain at the zoo and I thought I was having a miscarriage. We rushed for an emergency ultrasound, but they said baby was fine except for a small “retro placental bleed”. Nothing to do except go home and rest. Friday, I started having high fever, chills, fatigue, more abdominal pain – with a busy toddler I just brushed it off as “not feeling ... Read Full Story

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Annmarie Williams

Hi I am Annmarie. In 2010 I got a stomach bug and it’s changed my life. What ever the bug did affected my motility, then my gallbladder was removed. I ended up on IV nutrition in 2019. I have gastroparesis and likely severe sibo (small intestinal bacterial overgrowth). In 2020 January, I had sepsis, a bad pseudomonas infection. Luckily antibiotics worked. I then had another infection in April 2020 and a yeast infection after. (Sepsis and Bacterial Infections, Sepsis and Fungal Infections) Some how I fell pregnant with twins in June but didn’t know until September when I was 18 ... Read Full Story

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Patricia Croft

Hi, My name is Patty. This goes back a few years to May 1986. I felt very sick the last 4-6 weeks of my pregnancy. Bad migraines, low energy, just sick. Two weeks after birth of my son, I couldn’t take it any more so my husband took me the ER. They tested for everything and decided it was sepsis. (Sepsis and Pregnancy & Childbirth) I don’t remember anything else of the hospital stay except waking up and begging for pain shots. I was hooked up to IV. Finally after 5-6 days I kind of woke up to hear my ... Read Full Story

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Pregnancy & Childbirth

Although pregnancy is the same for people worldwide, their safety varies greatly depending on where they live and the type of medical care they receive, if any.

Sepsis is an illness that can develop during pregnancy, as well as after delivery. 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 incorrectly called blood poisoning, sepsis is the body’s often deadly inflammatory response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Sepsis kills and disables millions, more than breast cancer, lung cancer, and stroke combined.