All too often, we see the life-changing consequences caused to patients as a result of delays in diagnosis. While delays in diagnosis can occur in numerous areas of medicine, a particular concern are delays in diagnosis of infection in pregnant women. Maternal deaths from pregnancy related to sepsis (blood infection) while uncommon still occur at an unacceptably high rate. Disturbingly, deaths due to maternal sepsis increased in the United States from 1998 to 2008. A recent study demonstrates that maternal deaths from sepsis may be preventable with better recognition of the signs of early sepsis, prompt administration of appropriate antibiotics and the escalation of medical care as needed.
The Journal of Obstetrics and Gynecology published a recent study titled, “Maternal Deaths Due to Sepsis in the State of Michigan, 1999-2006.” The investigators conducted a case series of maternal deaths in the state of Michigan from 1999 to 2006. The study identified 151 maternal deaths during the period of time. More importantly, the study determined that 15% (22/151) of these women died from sepsis. Furthermore, the study concluded that 25% of the women who died from sepsis were never documented with a fever. The majority of the women that died from sepsis, however, displayed at least one of the abnormal vital signs captured by a proposed maternal early warning system: tachycardia (increased heart rate), tachypnea (rapid breathing), hypotension (low blood pressure), and hypoxemia (low oxygen in the blood).
Of particular note to pregnant women across Pennsylvania, is the study finding that in 73% of the women who died, initial antibiotic therapy was deemed by the investigators to be inadequate. Moreover, in the group of pregnant women that died, delays in treatment were identified by subsequent changes in care to appropriate antibiotic regimens following consultation with infectious disease specialists or intensivists. The study found that there were delays in the escalation of care in 53% of the cases.
The observations of this study led to the following suggestions:
- Practitioners should consider maternal sepsis in critically ill women even in the absence of fever;
- administer early appropriate antibiotic therapy and use consultation (maternal fetal medicine, infectious disease, critical care, etc.) early if there is marked derangement in vital signs or an inadequate response;
- vital sign derangement should be investigated, closely monitored, and, if severe, should prompt escalation of care; and
- vital signs should be accurately taken at appropriate intervals consistent with the maternal condition.
The takeaway for pregnant women is that individual symptoms as referenced herein, even in the absence of fever, must be taken seriously and brought to the attention of medical practitioners immediately.