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Updated: In the UK, signs of severe maternal sepsis should be regarded as an obstetric emergency


**Please note the following correction: The authors found an incidence of severe maternal sepsis of 4.7 women per 10,000.

In the UK, about 50 pregnant and postnatal women develop life-threatening severe maternal sepsis (infection of the blood or "blood poisoning") for every woman who dies from the condition, according to a study from UK researchers published in this week's PLOS Medicine. The study also suggests that signs of severe sepsis should be regarded as an obstetric emergency, and that doctors should be aware that prescribing antibiotics does not necessarily prevent progression of an infection to severe sepsis.

The authors, led by Professor Marian Knight from the University of Oxford, also found that the onset of severe sepsis is often very rapid, and women who have recently had an infection, such as a urine, genital tract or respiratory infection, are at particularly high risk of developing severe maternal sepsis.

The authors reached these conclusions by examining information from the United Kingdom Obstetric Surveillance System (a system in which obstetricians from all hospitals around the UK send clinical information to a central point) between June 2011 and May 2012.

Over this time period, the authors found that there were 365 cases of maternal sepsis, giving an incidence of severe maternal sepsis of 4.7 women per 10,000**. Seventy-one women with severe sepsis (19.5% of cases) developed septic shock, and five women (1.4% of cases) died. The most common source of sepsis (implicated in about a third of cases) was a genital tract infection. The authors also found that having a fever, taking antibiotics in the two weeks preceding sepsis, and all types of operative delivery (including caesarean section) were risk factors for maternal sepsis.

These findings suggest that pregnant or recently pregnant women with an infection need closer attention than women who are not pregnant, and also that adequate follow-up is necessary to ensure eradication of the infection.

The authors say: "This study emphasizes that both primary and secondary care practitioners should remain aware that pregnant or recently pregnant women with suspected infection need closer attention than women who are not pregnant."

They continue: "Antibiotic prescription does not necessarily prevent progression to severe sepsis, and women should be followed up to ensure recovery.

Professor Knight adds: "Women should be aware that if their symptoms persist they should seek further advice from their doctor or midwife."


Research Article

Funding: This article presents independent research funded by the National Institute for Health Research (NIHR) under the ''Beyond maternal death: Improving the quality of maternity care through national studies of 'near-miss' maternal morbidity'' program (Programme Grant RP-PG-0608-10038). MK is funded by a National Institute for Health Research (NIHR) Professorship. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: SS is Chair of the Claims Advisory Committee at the Medical Protection Society for which she receives an honorarium. All other authors have declared that no competing interests exist.

Citation: Acosta CD, Kurinczuk JJ, Lucas DN, Tuffnell DJ, Sellers S, et al. (2014) Severe Maternal Sepsis in the UK, 2011�: A National Case-Control Study. PLoS Med 11(7): e1001672. doi:10.1371/journal.pmed.1001672

Author Affiliations:

University of Oxford, UNITED KINGDOM

Northwick Park Hospital, UNITED KINGDOM

Bradford Hospitals NHS Trust, UNITED KINGDOM

University Hospitals Bristol NHS Trust, UNITED KINGDOM




Professor Marian Knight
NIHR Research Professor/Honorary Consultant in Public Health
National Perinatal Epidemiology Unit
Nuffield Department of Population Health
University of Oxford
+44 1865 289 727

Notes to Editors

* The study was funded by the National Institute of Health Research Programme Grants for Applied Research (NIHR) PGfAR Programme. (Project reference: RP-PG-0608-10038

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (

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