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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Maternal sepsis and critical illness

Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending

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Suspected infection with maternal deterioration

A pregnant or recently pregnant patient with altered mental state, marked tachypnoea, hypotension, hypoxaemia or reduced urine output may have sepsis despite a normal temperature. Rapid progression can occur before a source becomes obvious.

Action: Activate emergency assessment and obtain senior obstetric, anaesthetic and medical support. In the community, arrange immediate emergency transfer and pre-alert the receiving team. In hospital, assess ABCDE, obtain lactate and cultures promptly, give indicated intravenous antibiotics within one hour of high-risk recognition, and begin monitored resuscitation and source investigation.

Synopsis

Recognise infection with maternal organ dysfunction, initiate timely resuscitation and antimicrobial treatment, and coordinate source control, obstetric decisions and recovery after critical illness.

  • NICE NG255 is the pregnancy and recently pregnant sepsis guideline; use its population-specific risk assessment rather than automatically applying the general adult NEWS2 pathway.
  • Recently pregnant includes the six weeks after birth, miscarriage or termination, so establish pregnancy history in any unwell patient.
  • A normal temperature or an initially normal blood pressure cannot reliably exclude serious maternal infection.
  • High-risk suspected sepsis requires prompt broad-spectrum intravenous antimicrobials, within one hour of identifying a high-risk criterion.
  • Obtain appropriate cultures before treatment when this can be achieved promptly; difficult sampling must not create harmful antibiotic delay.
  • Reassess after each fluid bolus and obtain early critical care input when shock, respiratory failure or organ dysfunction persists.
  • Antibiotics and resuscitation do not replace drainage, debridement or removal of infected retained pregnancy tissue when source control is needed.

Key red flags

New confusion, unusual behaviour, reduced consciousness or a family report that the patient is markedly different from usual.

Respiratory rate of 25/minute or above, escalating oxygen requirement or blue, mottled or ashen skin.

Systolic pressure of 90 mmHg or less, substantial fall from baseline, or heart rate above 130/minute with suspected infection.

No urine for 18 hours, measured oliguria or biochemical evidence of acute kidney injury.

Severe wound or perineal pain out of proportion to visible changes, spreading bruising or rapidly worsening abdominal pain.

Investigation priorities

01
Blood gas with lactate and glucoseFirst step

Assess perfusion, metabolic disturbance and early treatment response.

Management branches

High-risk presentationTreat and escalate within the first hour

Suspected infection is accompanied by at least one high-risk pregnancy sepsis criterion.

  1. Request immediate assessment by a senior clinical decision maker, discuss with a consultant and involve maternity, anaesthesia and critical care according to the pattern of deterioration.
  2. Assess airway and breathing, provide oxygen when needed to reach the appropriate target, establish intravenous access and obtain blood gas, cultures and organ-function studies.
  3. Administer broad-spectrum intravenous antimicrobials without delay and within one hour of high-risk recognition. Select coverage using the likely source, allergy history, recent antibiotics and resistant-organism risk, with early infection specialist advice.
  4. Give monitored intravenous crystalloid when indicated. In high-risk patients, lactate 2–4 mmol/L warrants a bolus; lactate above 4 mmol/L or systolic pressure at or below 90 mmHg additionally prompts critical care review.
  5. Monitor continuously where possible, or at least every 30 minutes according to setting. If there is inadequate response within one hour of intervention, request consultant attendance in person and reassess resuscitation, diagnosis and source control.

Key medicines

Intravenous crystalloidFor patients aged 16 or over needing resuscitation, NG255 specifies 500 mL of crystalloid containing sodium 130–154 mmol/L over less than 15 minutes. Reassess immediately; a further bolus requires assessment of perfusion and pulmonary congestion.Avoid automatic repeated litres in patients with pre-eclampsia, cardiac disease or renal impairment. Persistent poor response after a second bolus requires consultant attendance, with early critical care involvement for shock rather than continuing fluids without review.
Piperacillin with tazobactamAn example component of broad empirical treatment for life-threatening sepsis is 4 g/0.5 g intravenously every 6 hours for particularly severe infection, infused over 30 minutes with this SmPC regimen. Usual less-severe indicated infections use an 8-hour interval; adjust ongoing dosing for renal impairment.This is not a universal maternal sepsis prescription. RCOG describes combination with clindamycin for life-threatening infection of uncertain sensitivity; severe beta-lactam allergy, suspected meningitis, MRSA or resistant Gram-negative organisms require a different or additional specialist-selected regimen.
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Sources and review status7 sources · checked 7 Sept 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

  • NICE NG255 managing suspected maternal sepsis
  • NICE NG255 antimicrobial fluid and oxygen treatment
  • NICE NG255 full guideline through NCBI Bookshelf
  • RCOG Green-top 64 identification and management of maternal sepsis
  • RCOG maternal sepsis full guideline publication
  • Piperacillin tazobactam product characteristics
  • Clindamycin intravenous product characteristics

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom