Saving Mothers' Lives: - Public Health Agency for Northern Ireland

7 Genital tract sepsis
Ann Harper
Genital tract sepsis: Specifi c recommendations
All health professionals must be aware of the symptoms and signs of maternal sepsis and critical
illness and of the rapid, potentially lethal course of severe sepsis and septic shock:
Maternal tachycardia, constant severe abdominal pain and tenderness are important early
features of genital tract sepsis that should prompt urgent medical review.
All maternity units should have guidelines for the investigation and management of genital tract sepsis.
If sepsis is suspected, regular frequent observations should be made and use of the Modifi ed Early
Obstetric Warning core (MEOWS) as recommended by this Report is crucial.
High dose broad-spectrum intravenous antibiotic treatment should be started immediately sepsis is
suspected, without waiting for microbiology results.
Summary of key fi ndings for 2003-05
Twenty-two women died in this triennium from genital tract sepsis. Of these, 18 Direct deaths are counted in
this Chapter. A further Direct death from sepsis following an illegal abortion, is counted in Chapter 6 - Early
pregnancy deaths. The remaining three were Late deaths which occurred more than six weeks after delivery,
outside the international defi nition for maternal deaths. These Late Direct deaths are counted in Chapter
14 but are discussed here. Genital tract infection was also a leading co-factor in a further Late Direct death
which was attributed to thromboembolism associated with an infected retained vaginal tampon.
Table 7.1
Direct deaths associated with genital tract sepsis and rate per 100,000 maternities;
United Kingdom: 1985-2005.
Triennium Sepsis
in early
pregnancy*
Puerperal
sepsis
Sepsis after
surgical
procedures
Sepsis
before or
during
labour
All Direct deaths from sepsis counted in
this chapter
Direct deaths
from sepsis
counted as
early pregnancy
deaths
Late
deaths**
from
sepsis
Number Rate 95 per cent CI Number Number
1985-87 3 2 2 2 9 0.40 0.21 0.75 0 0
1988-90 8 4 5 0 17 0.72 0.45 1.15 0 0
1991-93 4 4 5 2 15 0.65 0.39 1.07 0 0
1994-96 0 11 3 1 16 0.73 0.45 1.18 2 0
1997-99 6 2 1 7 18 0.85 0.54 1.34 0 2
2000-02 2 5 3 1 13 0.65 0.38 1.11 2 0
2003-05 5 3 2 8 18 0.85 0.54 1.35 1 3
* Early pregnancy includes deaths following miscarriage, ectopic pregnancyand other causes.
** Late deaths are not counted in this Chapter or included in the numerator.
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