Sepsis during pregnancy and after childbirth

Sepsis is when your immune system reacts strongly to an infection, causing inflammation throughout your body. If it's not treated quickly, this can slow your blood flow and cause damage to your organs and limbs.

If you're pregnant, sepsis can reduce blood flow to your placenta and baby, which can cause your baby to be stressed.

If sepsis becomes worse it can cause your organs to start failing. This is called septic shock.

Sepsis can cause many different symptoms.

Sometimes the symptoms of sepsis are general, such as:

• fever (a temperature of 38℃ or higher)
• a temperature of less than 36℃
• being confused or drowsy
• abdominal (tummy) pain
• a fast heart rate
• a fast respiratory rate (breathing fast)

Sometimes the symptoms of sepsis are specific to where the infection started, such as:

• pain when passing urine (weeing)
• passing urine more often than usual
• pain where you have an intravenous cannula (IV)
• coughing or feeling breathless
• vomiting or diarrhoea
• vaginal discharge that has an odour (smell)

If you're pregnant you may notice:

• your baby's heart rate is faster than normal
• your baby's movements have changed
• you have pain in your uterus

You may have different symptoms of sepsis than someone else. If you are worried you might have sepsis, or you think something isn't right with your health, see your doctor.

Any type of infection can cause sepsis, including infection from a virus, bacteria or fungus.

During pregnancy

Sepsis during pregnancy can be caused by:

• urinary tract infection (UTI)
• respiratory infection, such as pneumonia
• infection of your intravenous cannula site
• chorioamnionitis (infection of the membrane surrounding your baby)

After birth

Sepsis after childbirth can be due to birth-related infections such as:

• infections in your amniotic fluid or placenta
• wound infection after a caesarean section (C-section) or perineal tear
• endometritis (uterus infection after birth)

What can increase my chance of having sepsis?

You have a higher risk of developing sepsis during pregnancy or after birth if you:

• have diabetes
• are immunocompromised (have a weakened immune system)
• have anaemia (low haemoglobin)
• are living with obesity
• have a history of pelvic infection
• have had a group A streptococcus infection in the past

During childbirth, some situations can make sepsis more likely to occur. Risk factors related to childbirth include:

• prolonged rupture of membranes (a long time between your waters breaking and your baby being born)
• long labour
• placental tissue left in your uterus after birth
• delivery by caesarean section

You should see your doctor or midwife as soon as possible if you:

• have symptoms of infection
• have any symptoms of sepsis
• are feeling unwell during your pregnancy or soon after your baby is born

If you have symptoms of sepsis such as infection, fever or difficulty breathing, see your doctor urgently, or go to your nearest emergency department or call triple zero (000) and ask for an ambulance.

Your doctor can diagnose sepsis by asking about your symptoms and examining you.

To help understand the cause of the infection your doctor may recommend further tests, such as:

• blood tests
• a wound swab
• a urine sample
• an x-ray
• an ultrasound

It's very important to treat sepsis quickly during pregnancy.

Medicines for sepsis

Your doctor or midwife will recommend you start taking antibiotics straight away. Your doctor or midwife do not have to wait for test results to begin antibiotic treatment.

In some situations, you will also be given an antiviral medicine.

Both pregnancy and sepsis increase your risk of developing a blood clot. You may be given a blood thinning medicine to reduce this risk.

Other treatments

Your baby will be monitored with a cardiotocograph (CTG), which is a device to measure your baby's heart rate. Sometimes, your baby will need to be born sooner than planned.

If you are very unwell with sepsis, you may need specialised care in an intensive care unit (ICU).

If you have retained placenta tissue in your uterus after giving birth, or a wound infection, you may need surgery.

It's common to have a fever when you have sepsis. Having a fever during pregnancy can increase your baby's chance of congenital anomalies (birth differences) and miscarriage.

If you have sepsis, an early birth may be recommended because it's safer for you and your baby. Your doctors will consider:

• how many weeks pregnant you are
• the type of infection you have
• if you are getting better with treatment
• how well your baby is, based on their heart rate

Most premature babies don't have any long-term health complications. Some babies born prematurely can have problems with:

• breathing
• eating
• growing

If your baby is likely to be born prematurely, you may be given corticosteroids to help prepare your baby's lungs for breathing.

If your baby is born prematurely they will usually receive antibiotics after birth. They may also need extra care in a special care nursery (SCN) or neonatal intensive care unit (NICU).

Even though sepsis is rare, it's one of the biggest causes of severe illness and death during pregnancy and after birth.

Around 1 in 2 adults will have chronic (long-term) complications after having sepsis, including:

• feeling tired
• difficulty concentrating
• pain when walking
• difficulty breathing
• post-traumatic stress disorder
• anxiety

Sepsis can cause permanent disability such as amputation (losing a limb).

Developing sepsis during pregnancy can affect future pregnancies if:

• there is long-term damage to your organs
• you need surgery
• you need to give birth early

If you have a caesarean section because your baby needs to be born early or urgently, it can affect future pregnancies. Your doctor will talk with you about:

• how long you should wait before having another baby
• having a vaginal birth after caesarean section
• whether a planned caesarean section is recommended for your next birth

If you have placental tissue remaining that is causing an infection, your doctor may recommend surgery to remove it. In rare cases, this can cause scarring to the lining of your uterus, which can make it harder to become pregnant in the future. There is a surgery to help remove this scar tissue if needed.

You can help reduce your risk of sepsis by preventing and treating infections. Some steps you can take include:

• promptly getting medical help if you become unwell
• staying up to date with your vaccinations
• washing your hands regularly

The Australian Commission on Safety and Quality in Health Care has:

• A Spotlight on Sepsis video that provides information about sepsis and when to seek help.
• A Spotlight on Sepsis video for Aboriginal and/or Torres Strait Islander people.
• A fact sheet of information for people with sepsis who are in hospital.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.