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.

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Faces of Maternal Sepsis

Shelley P.

Almost 32 years ago, I suffered sepsis during the C-section birth of my son after a long labor. (Sepsis and Pregnancy & Childbirth) A midwife broke my water and labor was induced but I failed to dilate sufficiently. Infection set in, an OB was finally called in, and he thought there was fetal-pelvic disproportion as my son was a very big baby. I delivered him after 22 hours, began to be very nauseous, my blood pressure dropped, and due to it not being known if he was actually septic, he was whisked quickly to NICU. I was semi-conscious for several ... 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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Vuyo Ndlovu

I’m a 40 year old female nurse with 17 years post experience after 4-year nursing course training. My story begins as follows. It was on the 11.01.2022 and I was pregnant approaching end of my 2nd trimester, this was the most precious moment in our life. We were in love since 2002 and this was our second pregnancy, in 2019 I had miscarriage. I woke up feeling okay, but in the morning hours, I started having uncontrolled shivering and my colleagues forced me to visit our occupation health clinic. I agreed and after consultation I went to sleep and rest ... Read Full Story

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Jennifer Inskip

I gave birth on 3/17/20. I was released after 4 days. The next day of being home, I started to feel ill. (Sepsis and Pregnancy & Childbirth) Heart racing, dizzy, chills. My OB recommended I wait it out due to the Covid situation in the hospitals. The next day, I was much worse. Couldn’t speak or barely breathe. Felt like I had pins and needles all over my body. My husband called 911. I was rushed to the hospital and diagnosed with severe sepsis from a UTI. (Sepsis and Urinary Tract Infections) I was on infusion antibiotics for 14 days ... Read Full Story

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Patricia Casey

It was 2009, I was pregnant and had a regular cold. The doctor turned me back because I was pregnant and sent me home with Tylenol. (Sepsis and Pregnancy & Childbirth) One week later, my cold turned into pneumonia to septic shock. (Sepsis and Pneumonia, Sepsis and Septic Shock) Things deteriorated fast, went straight to the ICU, had a miscarriage. My both lungs collapsed, was put on ECMO for 4days, lost 75% of my hair. One month later, survived went home and two months later got pregnant and had my daughter. No major issues today shortness of breath and a ... Read Full Story

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Related Content

CDC Reports Infection as a Major Cause of Maternal Death
Maternal Sepsis Survivor Becomes Sepsis Advocate
Regular Maternal Health Check-Ups OK During Pandemic
Why Maternal Sepsis Is Such an Important Topic
World Health Organization Issues Statement on Maternal Sepsis

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.

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