Suspected Maternal Sepsis
Pregnant or recently delivered patient with signs of infection
All Pathways
Obstetrics & GynecologyEmergency
Maternal Sepsis Management (RCOG 2024)
Maternal Sepsis Management (RCOG 2024): Suspected Maternal Sepsis → Recognize Sepsis - MEOWS → SEPSIS 6 - Within 1 Hour → Empiric Antibiotics → Source C...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Recognize Sepsis - MEOWS
Use modified early warning score for obstetrics
- Temp >38°C or <36°C
- HR >100-120 bpm (higher in pregnancy)
- RR >20-25/min
- SBP <90 mmHg or MAP <65
- Altered mental status
- Fetal tachycardia (if pregnant)
- Uterine tenderness, foul lochia
03Warning SEPSIS 6 - Within 1 Hour
Time-critical interventions
- 1. HIGH-FLOW OXYGEN (target SpO2 >94%)
- 2. BLOOD CULTURES before antibiotics
- 3. IV ANTIBIOTICS within 1 hour
- 4. IV FLUIDS - 30mL/kg crystalloid
- 5. LACTATE measurement
- 6. URINE OUTPUT monitoring (Foley)
04Action Empiric Antibiotics
Broad spectrum, cover likely sources
- CHORIOAMNIONITIS: Ampicillin 2g IV q6h + Gentamicin
- ENDOMETRITIS: Clindamycin + Gentamicin (or Amp-Gent)
- UNKNOWN SOURCE: Pip-Tazo 4.5g IV q6h
- ADD Clindamycin if GAS suspected (toxin suppression)
- If penicillin allergy: Vanc + Aztreonam or Meropenem
05Decision Source Control Needed?
May require procedural intervention
06Action Source Control Procedures
Remove/drain infectious focus
- D&C for retained products
- Delivery if chorioamnionitis (often indicated)
- Wound debridement
- Abscess drainage (breast, pelvic)
- Hysterectomy if refractory endometritis (rare)
- Laparotomy for peritonitis
07Action Fetal Considerations (If Undelivered)
Continuous monitoring, delivery decisions
- Continuous fetal monitoring
- Maternal stabilization priority
- Delivery may be source control
- Consider GA at time of delivery decision
- Steroids if preterm and time permits
08Outcome Outcome
Recovery with appropriate treatment
- Most patients recover with prompt treatment
- Complete antibiotic course (typically 7-14 days)
- Debrief and document
- Counsel on signs of recurrence
09Decision Septic Shock?
Hypotension despite fluids, elevated lactate
- MAP <65 despite fluid resuscitation
- Lactate >2 mmol/L
- Need for vasopressors
10Action ICU/Critical Care Management
For septic shock or organ dysfunction
- Vasopressors: Norepinephrine first-line
- Central venous access
- Arterial line for BP monitoring
- Consider stress-dose steroids if refractory shock
- Mechanical ventilation if needed
- VTE prophylaxis when stable
- Path rejoins step 07Shared downstream outcome
11Action Ongoing Monitoring
Track response to treatment
- Vitals q1-2h initially
- Serial lactate (target clearance)
- Urine output >0.5 mL/kg/hr
- Daily CBC, CRP, procalcitonin
- Reassess antibiotics at 48-72h (culture results)
- Path rejoins step 08Shared downstream outcome
12Action Identify Source
Common sources in obstetric sepsis
- GENITAL TRACT: Chorioamnionitis, endometritis, wound infection
- URINARY: Pyelonephritis, UTI
- BREAST: Mastitis, breast abscess
- RESPIRATORY: Pneumonia
- Consider: retained products, septic pelvic thrombophlebitis
- Path rejoins step 05Shared downstream outcome
13Warning ⚠️ Group A Strep (GAS)
Can be rapidly fatal - high vigilance
- Can progress to death in hours
- Presents with sore throat, rash, diarrhea
- Early shock disproportionate to signs
- ADD CLINDAMYCIN (suppresses toxin)
- Consider IVIG in refractory cases
Guideline Source
RCOG Green-top Guideline No. 64: Maternal Sepsis
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Pregnancy masks sepsis signs (baseline tachycardia, tachypnea)
- Modified early warning scores for obstetrics needed
- Source control may require delivery
- GAS (Group A Strep) sepsis can be rapidly fatal
Applicable Regions
USUKEUGlobal
UK: Based on RCOG 2024 guideline
US: SSC guidelines apply; pregnancy-specific considerations
Version 1Next review: 2027-01-01
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Related Resources
Frequently Asked Questions
What is the Maternal Sepsis Management (RCOG 2024)?
The Maternal Sepsis Management (RCOG 2024) is a emergency clinical algorithm for Obstetrics & Gynecology. It provides a structured decision tree to guide clinical decision-making, based on RCOG Green-top Guideline No. 64: Maternal Sepsis.
What guideline is the Maternal Sepsis Management (RCOG 2024) based on?
This algorithm is based on RCOG Green-top Guideline No. 64: Maternal Sepsis (DOI: 10.1111/1471-0528.18009).
What are the limitations of the Maternal Sepsis Management (RCOG 2024)?
Known limitations include: Pregnancy masks sepsis signs (baseline tachycardia, tachypnea); Modified early warning scores for obstetrics needed; Source control may require delivery; GAS (Group A Strep) sepsis can be rapidly fatal. Individual patient factors may require deviation from these recommendations.
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