Abstract

The 2006-08 Saving Mothers' Lives Report recommends that all maternity services should use existing guidelines to develop their own clinical guideline for the identification and management of pregnancy-related sepsis by the end of December 2011.

A recent audit of our maternity unit's compliance with our local Trust Management of Severe Sepsis Guidelines identified serious deficiencies in care provision – delay in recognition of severe sepsis, incomplete investigations and monitoring, delay in prescribing systemic antibiotics and in giving adequate doses, with an overall lack of senior involvement. Both midwifery and obstetric staff failed to recognise the importance of immediate aggressive treatment in the first “golden hour” of resuscitation in order to reduce maternal morbidity and mortality.

The 2008 International Guidelines for the Management of Severe Sepsis and Septic Shock have been adapted to the obstetric setting using our Early Warning Scoring Tool for Maternity Patients. A flowchart incorporating baseline observations, investigations, treatments to be instigated within 1 hour of diagnosis, multidisciplinary team involvement with triggers for referral has been developed by a group of obstetricians, midwives and anaesthetists. The flowchart includes a section on fetal investigations and monitoring for women with sepsis in the antenatal period.

It is hoped that the development of a Suspected Severe Sepsis Care Pathway specific to maternity patients incorporating the key recommendations made by the last Saving Mothers' Lives Report will improve care provision for our women and their unborn babies. A prospective audit measuring compliance with standards is planned for 2012.