Maternal sepsis: a comprehensive review from definition to treatment

Maternal mortality is a worldwide alarming concern, and sep- sis is the third most frequent cause for its occurrence. Pregnan- cy and the postpartum period are an intrinsically vulnerable period during women’s life, which may make the mothers more susceptible to develop sepsis, due to the physiologi- cal and immunological changes that regulate host capacity to counteract pathogens infection, such as bacteria, viruses, fungi, and protozoa. The physiological adaptations of preg- nancy could additionally mask signs and symptoms of infec- tion and limit the sensitivity and specificity of the available scores. On this basis, the obstetric-modified quick SOFA and the Modified Early Warning System were proposed to over- come these issues. Early recognition and treatment are vital to prevent mortality. Nevertheless, the evidence guiding the current management of maternal sepsis are derived from the general population and do not take into account the physio- logical changes of pregnancy. In pregnant women early fluid resuscitation should be carefully addressed, and the manage- ment of the source of infection may require expedite delivery, making the management of sepsis particularly challenging during gestation. Further studies are needed to establish preg- nancy-related diagnostic criteria and therapeutic protocols for sepsis and septic shock in the obstetrical population.