Are maternity medics being encouraged enough to “Think Sepsis”?

The MBRRACE report 'MBRRACE-UK: Saving Lives, Improving Mothers' Care 2020: Lessons to inform maternity care from the UK and Ireland Confidential Enquiries in Maternal Death and Morbidity 2016-18' made a number of key recommendations.

All health professionals should offer influenza vaccine to pregnant women at any stage of pregnancy.

Furthermore, women who do not speak English should be provided with an interpreter (who may be a link worker or advocate and should not be a member of the woman’s family, her legal guardian or her partner) who can enable communication in her preferred language. Health professionals should ensure the woman understands the information given to her.

Perhaps most importantly in relation to sepsis deaths, staff are should be encouraged to “Think Sepsis” at an early stage when presented with an unwell pregnant or recently pregnant woman. They should then take the appropriate observations and act on them. Most Trusts will have their own sepsis management protocols for staff to follow.

In the postnatal period health professionals must perform and record a full set of physiological vital signs, pulse, blood pressure, temperature and respiratory rate, in any woman with symptoms or signs of ill health.

Midwives and others carrying out these postnatal checks in the community should also have a thermometer to enable them to check the temperature of women who are unwell.

Finally, when assessing a woman who is unwell consider her condition in addition to her MEOWS (Modified Early Obstetric Warning Score). A MEOWS chart will record basic observations including, temperature, heart rate, respiratory rate and diastolic and systolic blood pressure, urine output and consciousness level.

If a maternal death does occur, they should all be referred to the coroner for investigation by way of an inquest hearing. Further information about inquests can be found here. In addition, medical staff will be expected to notify MCCRACE-UK of a maternal death.

A maternal infection case example, what can go wrong?

We represented a woman who contracted a Group A Strep infection following the delivery of her baby in hospital.

After the birth the mother received care at home from her community midwife and was complaining of feeling generally unwell, with a temperature and a perineal wound which was causing significant and worsening pain. Despite these early warning signs the mother was not referred back to hospital for further tests and her infection continued to worsen. Within days she collapsed and was transferred by ambulance to hospital; her family were advised the chances of saving her life were slim.

The obstetrician was forced to undertake an emergency hysterectomy as the infection had travelled into her uterus from her perineal wound. The woman was suffering from septic shock and after the operation had to be placed on life support in intensive care.

Luckily for this mother, she survived her ordeal, albeit with some residual problems such as kidney damage. She was unable to have any more children to complete her family and her infection was so severe that it took her months to recover. She therefore required high levels of care and support from her family. The outcome could have been much different though if the “Think Sepsis” protocol recommended by MBRRACE had been followed.

It is clear from the statistics presented by MBRRACE, and from stories like the one presented here, that maternity staff are not encouraged enough to “Think Sepsis”. Hopefully though, with raised training of maternity staff and awareness of the early signs of infection or sepsis, maternal deaths levels can continue to be reduced.

What is MBRRACE?

MBRRACE-UK is a collaborative body appointed by the Healthcare Quality Improvement Partnership to run a programme which collates all data relating to maternal deaths during pregnancy and up to six weeks after pregnancy.

MBRRACE also collate information concerning stillbirths and infant deaths. The aim of the organisation is to collate accurate information to inform the delivery of safe, equitable, high quality patient-centred care in the UK.