Top 10 pearls for the recognition, evaluation, and management of maternal sepsis
Open accessAbstract
Maternal sepsis is an obstetric emergency and a leading cause of maternal morbidity and mortality. Early recognition in a pregnant or postpartum patient can be a challenge as the normal physiologic changes of pregnancy may mask the signs and symptoms of sepsis. Bedside assessment tools may aid in the detection of maternal sepsis. Timely and targeted antibiotic therapy and fluid resuscitation are critical for survival in patients with suspected sepsis. Once diagnosed, a search for etiologies and early application of source control measures will further reduce harms. If the patient is in septic shock or not responding to initial treatment, multidisciplinary consultation and escalation of care is necessary. Health care professionals should be aware of the unique complications of sepsis in critically ill pregnant and postpartum patients, and measures to prevent poor outcomes in this population. Adverse pregnancy outcomes may occur in association with sepsis, and should be anticipated and prevented when possible, or managed appropriately when they occur. Using a standardized approach to the patient with suspected sepsis may reduce maternal morbidity and mortality.
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Influenza virus (such as novel coronavirus), varicella zoster virus and herpes simplex virus are common obstetric sepsis related viruses, which often show pneumonia.
“Influenza virus (such as novel coronavirus), varicella zoster virus and herpes simplex virus are common obstetric sepsis related viruses,33 which often show pneumonia.34”
From Clinical and Pathogenic Characteristics of 45 Cases of Bloodstream Infection in Obstetrics: A Clinical Analysis (2026) · cites this paper as [33]
Pearl 5 identifies influenza, varicella zoster, and herpes simplex virus as the most common viral pathogens associated with maternal sepsis. It discusses SARS-CoV-2 separately, not as a type of influenza, so the parenthetical is unsupported. The pneumonia clause carries a different citation in the citing sentence. (LLM, conf=0.88)
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- [4]The California Pregnancy-Associated Mortality Review. Report from 2002 and 2003 maternal death reviews. California Department of Public Health, Maternal Child and Adolescent Health Division; 2011.
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2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department
Guarino, M., Perna, B., Cesaro, A. E., Maritati, M., Spampinato, M. D., Contini, C., & GIORGIO, R. D. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093188 · Cited by 320 · see citing works
Society for Maternal-Fetal Medicine Consult Series #67: Maternal sepsis
Shields, A. D., Plante, L. A., Pacheco, L. D., & Louis, J. M. (2023) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2023.05.019 · Cited by 79 · see citing works
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Shaker, M., & Smith, A. (2022) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2022.04.004 · Cited by 11 · see citing works
Pré-Natal de Risco Habitual: Condução pelo Médico Generalista
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Global incidence of maternal sepsis: A systematic review and meta-analysis
Chen, Y., Lv, H., Fang, W., Zhang, X. C., & Huang, L. (2025) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2025.102940 · Cited by 9 · see citing works
Baguiya, A., Bonet, M., Brizuela, V., Cuesta, C., Knight, M., Lumbiganon, P., Abalos, E. J., & Kouanda, S. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0003109 · Cited by 8 · see citing works
Clinical findings predictive of maternal adverse outcomes with pyelonephritis
Stephens, A. J., Baker, A. L., Barton, J. R., Chauhan, S. P., & Sibai, B. M. (2021) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2021.100558 · Cited by 7 · see citing works
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Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score
Stephens, A., Lee, K. H., Barton, J., Chauhan, S., Baker, A., & Sibai, B. (2022) · American Journal of Perinatology · doi:10.1055/a-1884-1001 · Cited by 6 · see citing works
Maternal sepsis: background, diagnosis and management
Manigrasso, J., Desai, N., & Naoum, E. (2024) · BJA Education · doi:10.1016/j.bjae.2024.06.004 · Cited by 5 · see citing works
Sepsis as a driver of excess severe maternal morbidity and mortality in the rural United States
Brakebill, A., Katzman, H. R., & Admon, L. K. (2024) · Seminars in Perinatology · doi:10.1016/j.semperi.2024.151978 · Cited by 5 · see citing works
Infection after cesarean delivery: diagnosis, pathophysiology, management, and prevention
Duff, P. (2026) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2025.08.007 · Cited by 5 · see citing works
Qin, C., Liu, M., & Liu, J. (2024) · Journal of Global Health · doi:10.7189/jogh.14.04130 · Cited by 5 · see citing works
Obstetric Sepsis: A Review Article
Nayak, A. H., & Khade, S. A. (2022) · The Journal of Obstetrics and Gynecology of India · doi:10.1007/s13224-022-01706-y · Cited by 5 · see citing works
Chatterton, C. G., Romero, R. J., Jung, E., Gallo, D. M., Suksai, M., Primera, R. J. D., Erez, O., Chaemsaithong, P., Tarca, A. L., Gotsch, F., et al. (2023) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2023.2183470 · Cited by 7 · see citing works
Wang, S.-Q., Chen, S., Chen, M., Xu, W., Wu, Z.-R., Hu, X., Li, C., Xiao, Z.-H., Ma, B., & Cheng, L.-M. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-096746 · Cited by 5 · see citing works
Maternal deaths from sepsis in the Nordic countries during 2005–2021: A descriptive study
Kvalvik, S., Åmark, H., Helmig, R., Gissler, M., Nyfløt, L., Skrede, S., Vangen, S., Rasmussen, S., & Baghestan, E. (2025) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.70011 · Cited by 3 · see citing works
Best therapeutic practices in the management of obstetric sepsis
Gorecki, G. P., Balalau, O. D., Comandasu, D. E., Stănescu, A. D., & Tomescu, D. R. (2023) · Journal of Mind and Medical Sciences · doi:10.22543/2392-7674.1436 · Cited by 4 · see citing works
Association of Peripartum Lactate Levels With Infection Outcomes
Aguilera, M., Hoffman, S., Wunderlich, W. L., WATSON, D. A., Vacquier, M. C., & Sidebottom, A. C. (2024) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2023.12.008 · Cited by 3 · see citing works
Analysis of uroseptic shock after ureteroscopy for ureteral calculi during pregnancy: a case report
Tang, W., Xie, Z., Liu, M., Zhao, Z., & Wu, T. (2023) · BMC Urology · doi:10.1186/s12894-023-01299-2 · Cited by 3 · see citing works
Antibiotic Considerations in the Treatment of Maternal Sepsis
White, S., Heine, R. P., & Widelock, T. (2025) · Antibiotics · doi:10.3390/antibiotics14040387 · Cited by 3 · see citing works
Maternal sepsis due to Bacteroides fragilis: a case report and review of the literature
Shittu, S. A., Athar, S., Khyatt, O., Chaponda, M., Thodi, V., Al-Maslamani, K., & Alansari, L. M. (2025) · Journal of Medical Case Reports · doi:10.1186/s13256-025-05401-0 · Cited by 3 · see citing works
Ozarslan, N., Gaw, S., Cassidy, A., & Caughey, A. (2023) · Journal of Perinatology · doi:10.1038/s41372-023-01696-3 · Cited by 2 · see citing works
Pregnancy-Related Deaths by Hispanic Origin, United States, 2009–2018
Parker-Collins, W., Njie, F., Goodman, D. A., Cox, S. N., Chang, J., Petersen, E. E., & Beauregard, J. L. (2023) · Journal of Women s Health · doi:10.1089/jwh.2023.0057 · Cited by 3 · see citing works
Li, J., Zhou, M., He, C., & Liang, F. (2023) · Medicine · doi:10.1097/md.0000000000034141 · Cited by 2 · see citing works
Detlefs, S. E., Sheikh, M., & Detlefs, C. (2025) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-025-00429-x · Cited by 2 · see citing works
Progressive multiple organ dysfunction syndrome in adolescent pregnancy: Case report
Boock, J. R., Strickler, A. L., Silva, M. T., Loreto, T. M., & Carolina, L. D. (2023) · Medwave · doi:10.5867/medwave.2023.09.2716 · Cited by 2 · see citing works
BAYALIEVA, A. Z., & Рустэмовна, Д. В. (2024) · Obstetrics Gynecology and Reproduction · doi:10.17749/2313-7347/ob.gyn.rep.2024.509 · Cited by 2 · see citing works
Prevention and management of infectious diseases in pregnant women with haematological malignancies
Gaultier, S., Tazi, A., Charre, C., Paugam, A., Chouchana, L., Benaboud, S., Lachâtre, M., Baud, O., Fischer, C., Richebé, P., et al. (2025) · The Lancet Haematology · doi:10.1016/s2352-3026(25)00165-6 · Cited by 3 · see citing works
Kulikov, A. V., Shifman, E. M., Николаевич, П. Д., Ovezov, A. M., Ronenson, A. M., Raspopin, Y. S., Артымук, Н. В., Belokrinitskaya, T. E., Николаевич, З. К., Щеголев, А. В., et al. (2023) · Annals of critical care · doi:10.21320/1818-474x-2023-2-7-44 · Cited by 1 · see citing works
Maternal Sepsis: The Diagnostic Challenge in a Comorbid Patient in Mexico
Ramos, Y. C., Amador, F. O. V., Orive, S. A. B., Tapia, C. P. R., & Carrasco, J. C. L. (2024) · Cureus · doi:10.7759/cureus.76695 · Cited by 1 · see citing works
Postpartum maternal tachycardia – diagnostic pitfalls!
Mathur, C., Tohani, A., Patil, V., Khan, A., & Otigbah, C. (2023) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000895 · Cited by 1 · see citing works
Prevention and Management of Puerperal Infection
Andino, G. E. Y., León, M. F. C., Flores, G. C. V., Tarira, L. A. L., Quiñónez, K. Y. M., Tomalá, D. S. D., Ramírez, Á. G. C., Guijarro, E. M. V., Alay, D. F. V., Román, A. A. S., et al. (2025) · Obstetrics and gynecology. · doi:10.5772/intechopen.1006930 · Cited by 1 · see citing works
Inpatient Management and OBICU Care for Pregnant Patients With Severe COVID-19 Disease
Vaught, A. “. J. (2021) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000683 · Cited by 1 · see citing works
Antibiotics, Antivirals, and Antifungals in Critical Care
Shamshirsaz, A. A., & Vaught, A. “. J. (2024) · Wiley eBooks · doi:10.1002/9781119820260.ch19 · Cited by 1 · see citing works
Abdel‐Razeq, S. S. (2024) · doi:10.1002/9781119820260.ch38 · Cited by 1 · see citing works
Xie, J., Zhu, L., Wu, T., & Li, G. (2026) · Infection and Drug Resistance · doi:10.2147/idr.s609224
Prise en charge d’un état de choc en cours de grossesse
Bruyère, M. (2022) · Le Praticien en Anesthésie Réanimation · doi:10.1016/j.pratan.2022.01.001
Actualización en sepsis materna: diagnóstico y tratamiento
Uyaguari, C. E. V., & Suárez, C. A. E. (2022) · Revista Ecuatoriana de Ciencia Tecnología e Innovación en Salud Pública · doi:10.31790/inspilip.v6i1.274
Pyelonephritis and Urosepsis in a Preterm Dichorionic Diamniotic Twin Gestation
Price, C. R., & Ros, S. T. (2022) · NeoReviews · doi:10.1542/neo.23-7-e507
EPIDEMIOLOGY AND RISK FACTORS FOR MATERNAL SEPSIS
SAYDALIEVA, D. A., Dodkhoeva, M. F., & ABDULLAEVA, R. A. (2023) · Avicenna Bulletin · doi:10.25005/2074-0581-2023-25-2-248-259
Vaught, A. “. J. (2023) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-023-00370-x
Prevention of maternal death: a perspective
Leung, K. Y. (2024) · Hong Kong Journal of Gynaecology Obstetrics and Midwifery · doi:10.12809/hkjgom.24.1.362
Sepsis and Septic Shock in the Peripartum Period
Saadeddin, A. A., Amara, U. E., Nashrah, U., AlMulla, B. A., Ummunnisa, F., & Shaikh, N. (2024) · Springer eBooks · doi:10.1007/978-981-99-9577-6_3
Status Epilepticus Following Labor in a Remote Area: A Case Report of Puerperal Sepsis
Silalahi, A. M., Johansyah, T. K. P., Gusti, A., & Siswantoro, C. (2023) · Jurnal Kesehatan Reproduksi · doi:10.22146/jkr.87457
Reanimación de la mujer embarazada
Muller, M., Chamaraux-Tran, T., & Pottecher, J. (2024) · EMC - Ginecología-Obstetricia · doi:10.1016/s1283-081x(24)49116-9
Gadisa, E., Egyir, B., Adu, B., Ahmed, H., Disasa, G., & Tessema, T. S. (2024) · Clinica Chimica Acta · doi:10.1016/j.cca.2024.119201
Sinais e sintomas do trabalho de parto e consulta puerperal
Colen, M. F. F., de Olivares, A. V. O., Angulo, C. A., & Braga, M. G. B. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-7.2024
Diagnóstico e Classificação de Risco Gestacional
Tomaz, K. W. P., Rodrigues, H. M. T. D. S., Caetano, L. A. V., & Borges, A. D. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-2.2024
Tomaz, K. W. P., Fernandes, B. A., Trevisan, D. C. T., & Braga, M. G. B. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-4.2024
Medicações Utilizadas na Gestação
Colen, M. F. F., Pereira, A. C. V., Oliveira, B. R., & de Sousa, P. D. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-8.2024
Intercorrências clínicas gestacionais
Colen, M. F. F., Soares, L. S., Soares, T. H. V., & Beltrão, G. D. M. L. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-6.2024
Interpretações de Exames Laboratoriais e de Imagem
Colen, M. F. F., Magalhães, L. S. M. D. W., Santana, L. D. P., & Borges, A. D. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-5.2024
Tomaz, K. W. P., Braga, L. S., Andrade, V. A. N. S., & Beltrão, G. D. M. L. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-1.2024
Alterações fisiológicas na gravidez
Tomaz, K. W. P., Barros, A. P., Curti, C. F., & de Sousa, P. D. D. O. (2024) · Editora Acervo eBooks · doi:10.25248/e-book.acervo.1-3.2024
Streptococcal toxic shock syndrome in the immediate postpartum period
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Intensive Care Considerations for the Critically Ill Pregnant Patient
Hensel, D. M., & Dombrowski, M. (2025) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2025.05.002
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- Authors
- Shields, A., de Assis, V., & Halscott, T.
- Affiliations
- University of Connecticut (US)
- Corresponding author
- Shields, Andrea
- ORCID
- Shields, Andrea
- Venue
- Obstetrics & Gynecology
- Published
- 2021-07-07
- Volume
- 138
- Issue
- 2
- Pages
- 289-304
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC8288480
- OpenAlex
- W3181951151
- Cited by
- 76
- References
- 91
- Citations by year
- 2026: 8 · 2025: 19 · 2024: 24 · 2023: 16 · 2022: 7 · 2021: 2
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Obstetrics and Gynecology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
- Keywords
- maternal sepsis, puerperal fever, obstetric emergencies, early recognition, antibiotic therapy, fluid resuscitation, source control, septic shock, multidisciplinary consultation, adverse pregnancy outcomes, maternal morbidity, maternal mortality
- MeSH terms
- Anti-Bacterial Agents, Female, Humans, Maternal Mortality, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Shock, Septic, Streptococcal Infections, Streptococcus pyogenes, Time Factors, Critical Illness, Postpartum Period
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