Too little, too late : the recurrent theme in maternal deaths due to sepsis

Abstract

BACKGROUND : Maternal sepsis accounts for 11% of direct obstetric deaths, making it the third commonest cause of death, after obstetric hemorrhage and hypertensive disorders. OBJECTIVE : To evaluate the risk factors and quality of care for maternal deaths due to sepsis. METHODS : Detailed secondary file review for all maternal deaths classified as pregnancy-related sepsis in South Africa between 2014-2016 and comparison of management with the Surviving Sepsis guidelines. RESULTS : There were 158 maternal deaths from sepsis. The postpartum period carried the greatest risk (94% of deaths), especially after caesarean delivery (50%). Adequate fluid resuscitation was done in only 25 cases (16%) and initiation of empiric antibiotics was often delayed (48% of those receiving antibiotics). Only 28% of women with possible source of infection in the uterus had a hysterectomy (39 cases). CONCLUSION : Healthcare professionals often underestimate the severity of maternal sepsis and poorly adhere to treatment guidelines.