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Surveillance of severe maternal sepsis

Principal investigator
Marian Knight (NPEU)
Susan Sellers (St Michael's Hospital, Bristol), Colleen Acosta-Nielsen (NPEU (Former member)), Peter Brocklehurst (NPEU), Jenny Kurinczuk (NPEU)
Severe maternal morbidity and mortality
National Institute for Health Research
Start year
End year
NPEU Contact
Marian Knight


Key points

  • Maternal death from sepsis is increasing in countries with advanced healthcare systems. Sepsis is now the leading cause of direct maternal death in the UK.
  • The objectives of this national prospective case-control study were to estimate the incidence, describe the causative organisms and sources of infection, and identify the risk factors for severe maternal sepsis in the UK.
  • There were 365 confirmed cases of severe maternal sepsis between June 2011 and May 2012, an incidence of 4.7 (95% CI 4.2–5.2) per 10,000 maternities; 71 (19.5%) women developed septic shock; and five (1.4%) women died.
  • Genital tract infection (31.0%) and the organism E coli (21.1%) were most common.
  • Women had significantly increased adjusted odds of severe sepsis if they were black or other ethnic minority (aOR = 1.82; 95% CI 1.82–2.51), were primiparous (aOR = 1.60; 95% CI 1.17–2.20), had a pre-existing medical problem (aOR = 1.40; 95% CI 1.005–1.94), had febrile illness or were taking antibiotics in the two weeks prior to presentation (aOR = 12.07; 95% CI 8.11–17.97).
  • All forms of operative delivery were associated with increased risk of sepsis.
  • Multiple pregnancy (aOR = 5.75; 95% CI 1.54–21.45) and infection with group A streptococcus (aOR = 4.84; 2.17–10.78) were associated with progression to septic shock.
  • This study suggests that for each maternal sepsis death, approximately 50 women have life threatening morbidity from sepsis. Follow-up to ensure infection is eradicated is important.
  • The rapid progression to severe sepsis highlights the importance of following the international Surviving Sepsis Campaign guideline of early administration of high-dose intravenous antibiotics within one hour of admission to hospital for any woman with suspected sepsis.
  • Signs of severe sepsis in peripartum women, particularly with confirmed or suspected group A streptococcal infection, should be regarded as an obstetric emergency.


Journal Articles