Maternal sepsis
Maternal sepsis is a life-threatening condition caused by infection during pregnancy, childbirth, after abortion or in the postpartum period. Early recognition and immediate treatment are essential because organ dysfunction and shock can develop rapidly.
At a glance
Quick facts
- Category
- Maternal emergency
- Cause
- Infection + organ dysfunction
- Timing
- Pregnancy through postpartum / post-abortion
- Warning signs
- Fever or low temperature, fast breathing, confusion
- Treatment
- Immediate antibiotics + resuscitation
- Priority
- Source control and monitoring
Dr. Fitsum Admasu Tinsae
General Medicine · Public Health · Digital Health
Reviewed for clinical accuracy, clarity and practical public-health context.
Names & terminology
How this entity may be named or searched
- Maternal sepsis
- Life-threatening organ dysfunction caused by infection during pregnancy, childbirth, after abortion or postpartum.
- Puerperal sepsis
- Older / narrower term often referring to postpartum genital-tract infection with systemic illness.
- Septic shock
- Sepsis with profound circulatory and metabolic abnormalities requiring urgent critical care.
- Source control
- Treating or removing the focus of infection, for example drainage or surgery when needed.
Structured entity profile
Clinical profile
Overview
WHO defines maternal sepsis as a life-threatening condition caused by infection during pregnancy, childbirth, after abortion or in the postpartum period. It remains a leading cause of maternal death and disability worldwide. [1] [2]
Maternal infection can arise from the uterus or genital tract, urinary tract, lungs, surgical wounds, abdominal infection or other sources. Sepsis develops when the body’s response to infection causes organ dysfunction. [2]
Symptoms and warning signs
Warning signs can include fever or abnormally low temperature, chills, fast breathing, shortness of breath, rapid heart rate, low blood pressure, low urine output, mottled or pale skin, severe pain and altered mental state. A postpartum patient can deteriorate even without a high fever. [2]
SYMPTOM MATRIX
Maternal sepsis can begin with non-specific symptoms
Recent pregnancy or childbirth should lower the threshold for urgent assessment of suspected infection.
- Fever or chills
- Lower abdominal / pelvic pain
- Foul-smelling discharge
- Painful urination
- Wound redness or discharge
- Fast breathing
- Rapid heart rate
- Low urine output
- Marked weakness
- Pale or mottled skin
- Confusion or reduced consciousness
- Low blood pressure or collapse
- Severe breathing difficulty
- Cold clammy skin
- Very low urine output
Suspected maternal sepsis is a medical emergency and should trigger immediate hospital assessment and treatment.
Diagnosis
Diagnosis is clinical and time-sensitive. Clinicians assess the likely infection source, vital signs, oxygenation, urine output and evidence of organ dysfunction. Blood tests commonly include blood count, renal and liver function, lactate and coagulation tests; cultures are collected when feasible without delaying antibiotics. [2]
Imaging and examination are directed toward the suspected source, such as retained products, wound infection, urinary infection, pneumonia or abdominal infection. Maternal sepsis can occur after vaginal or cesarean birth and after pregnancy loss or abortion. [1] [2]
Diagnostic pathway
Recognize infection plus organ dysfunction and treat in parallel
Maternal sepsis is not a diagnosis to wait for complete laboratory confirmation.
A normal temperature does not by itself exclude sepsis when other signs of infection or organ dysfunction are present. Source [1] Source [2]
Where maternal infection can come from
Potential sources include endometritis, retained placental tissue, cesarean or perineal wound infection, urinary tract infection, pneumonia and intra-abdominal infection. Source identification matters because antibiotics alone may be insufficient when retained tissue, an abscess or another surgically treatable focus is present. [1] [2]
Breast infection and infection after abortion are among the potential sources I specifically consider when assessing maternal sepsis.
Treatment and management
Treatment should begin immediately with broad-spectrum antibiotics appropriate to pregnancy/postpartum status and the suspected source, intravenous fluids when needed, oxygen and organ support, close monitoring and escalation to higher-level care for shock or organ failure. [2]
Source control may require evacuation of retained infected tissue, drainage of an abscess, wound treatment or surgery. WHO’s APT-Sepsis program emphasizes fluids, antibiotics, source control, transfer when required and monitoring as a structured response bundle. [3]
Treatment & care hub
Treat infection and organ dysfunction at the same time
Every delay in antibiotics or source control can worsen maternal outcomes.
Start effective antimicrobial treatment
Broad initial therapy is chosen according to likely source, severity and local resistance patterns.
Support circulation and breathing
Fluids, oxygen and critical-care support are escalated according to perfusion and organ dysfunction.
Remove the focus of infection
Drainage, uterine evacuation, wound treatment or surgery may be required.
Escalate early
Frequent vital signs, urine output and organ monitoring help identify deterioration and need for higher-level care.
Preventing maternal infection and sepsis
Prevention includes hand hygiene, clean birth and surgical practices, appropriate antibiotic prophylaxis for indicated procedures, early recognition of postpartum infection and reliable follow-up after discharge. A 2025 WHO-led trial found that a structured infection-prevention and sepsis-response program reduced infection-related maternal death and severe morbidity. [3]
Global maternal health
Maternal sepsis remains a leading direct cause of maternal mortality
WHO identifies maternal sepsis as the third leading direct cause of maternal mortality worldwide.
Common questions
Frequently asked questions
It is life-threatening organ dysfunction caused by infection during pregnancy, childbirth, after abortion or in the postpartum period.
No. Sepsis can occur with fever, low temperature or sometimes without a striking temperature abnormality; other signs of organ dysfunction are important.
Immediately. Antibiotics, resuscitation, monitoring and source control should begin as soon as sepsis is suspected.
Potential sources include uterine infection, retained tissue, urinary infection, wound infection, pneumonia and abdominal infection.
Many cases can be reduced through infection-prevention practices, appropriate prophylaxis, early detection and rapid treatment of maternal infections.
Sources
- WHO — Statement on maternal sepsis
- WHO — Sepsis — health topic
- WHO / HRP — Stronger infection prevention and management, better maternal outcomes
This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.
Low blood pressure can be a late feature of sepsis. Earlier warning signs may include a fast heart rate, altered mental status, reduced urine output, abnormal temperature and rapid breathing.