WASHINGTON, DC — While maternal sepsis is rare in the US, occurring in less than 1% of the sepsis population, it is responsible for 24% of intrapartum deaths and 38.4% of postpartum maternal deaths, said Andrea Shields, MD, professor and maternal-fetal medicine fellowship program director in the Department of Obstetrics and Gynecology at the University of Connecticut Health.

The 60 days postpartum is the time period where maternal sepsis is responsible for most deaths, Shields said during a presentation at the American College of Obstetricians & Gynecologists (ACOG) 2026 Annual Meeting. The condition is responsible for about 15% of pregnancy-related deaths, she said.

“These patients, when they’re admitted to our services tend to be more severely ill,” she said, citing data from the CDC. They tend to stay longer, not surprisingly, she said, and are eight times more likely to die than women without sepsis.

For every maternal sepsis death, there are approximately 50 women with life-threatening morbidity from sepsis, and both conditions appear to be increasing, Shields said. Risk factors for postpartum maternal sepsis include younger age at delivery, having Medicaid insurance, lower socioeconomic status, and chronic medical conditions such as obesity, diabetes, and hypertension.

Shields presented her top pearls for quickly recognizing and managing sepsis:

Maintain a high index of suspicion for maternal sepsis. Diagnosis of sepsis in pregnancy can be difficult as the population tends to be younger and fitter so the signs may not be as evident or may be explained by other reasons, Shields said. For example, white blood cell count and resting heart rate can be higher during labor. There also may be no obvious focus for infection as it often comes through the genitourinary tract, she said.

Common signs and symptoms include shortness of breath, palpitations, flu-like symptoms, and fever. However, not all patients present with fever and that is no longer required to make a diagnosis, she said. During pregnancy, look for leaking of vaginal fluid, decreased fetal movement, and preterm contractions. Postpartum, look for abdominal pain, abnormal vaginal discharge, and vaginal pain. The most common lab abnormality is leukocytosis.

Implement a rapid bedside tool for detection of maternal deterioration. Delays in care lead to maternal death in up to 63% of cases , Shields said. There are several published early-warning systems designed for use in maternity care, but most are not validated and have a tendency to overdetect sepsis and septic shock, she said. One study found the CMQCC and UKOSS tests performed best.

Bedside tools to screen for sepsis, adjusted for pregnancy, can be used between 20 weeks’ gestation and 3 days postpartum, Shields said. Avoid use of a one-step screen.

Implement sepsis bundles to facilitate rapid escalation of care. Create pathways to call a rapid response team to quickly review patient vitals and evidence of hemodynamic instability, Shields said, and if there are signs of sepsis, note your next moves. Initiating treatment with fluids and broad-spectrum antibiotics during the first “golden hour” of presentation can save lives. Obtain blood cultures prior to administration of antibiotics but don’t delay medications while waiting for the results, she said.

Identify etiology and pain source control. If sepsis is definite or probable, administer antimicrobials within an hour, even if shock isn’t present, Shields said. If shock is absent, you can give antimicrobials within 3 hours. In that case, consider alternative diagnoses such as anaphylaxis or pancreatitis, she said. Perform a bedside evaluation for organ dysfunction and consider lab tests like complete blood cell count with differential and urinalysis, or rapid molecular testing for pathogens. Imaging tests such as chest x-ray or ultrasound also can guide the assessment.

Know the most common organisms involved in maternal sepsis. Escherichia coli is the most common organism isolated from maternal sepsis cases, Shields said. But Group B and Group A Streptococcus (GAS) also are seen in intrapartum and postpartum cases. Choose antimicrobials tailored to the most likely diagnosis, she said. In the case of GAS, use penicillin G plus clindamycin.

The presentation “was great and very informative,” said Courtney Tafesse, MD, a locums ob/gyn in the Nashville, Tennessee, area who was in the audience. “She touched on topics that my hospital system hasn’t grossly addressed in that fashion, so I’ll be taking that back to my hospital system to discuss.”

Managing GAS with penicillin and clindamycin was a highlight, Tafesse told Medscape Medical News. “I wasn’t aware to add the clindamycin, so that’s something I learned new today.”

Shields reported being a founding member of Varda 5, LLC, which owns the exclusive sublicense for “Obstetric Life Support.” Tafesse reported having no relevant financial disclosures.

Karen Blum is a freelance medical/science writer in the Baltimore area.