Maternal Sepsis Review and Update

Abstract

Maternal sepsis rates are increasing and now rank as the second leading cause of preventable maternal mortality. The Centers for Medicare and Medicaid Services (CMS) has responded to this trend through the Severe Sepsis/Septic Shock Management Bundle (SEP-1) initiative, which aims to improve sepsis care and will be integrated into the Hospital Value-Based Purchasing program by 2026. This article provides an update on maternal sepsis definitions, screening, and management in line with recent CMS guidance. A comprehensive literature search was conducted with PubMed, Google Scholar, Scholar GPT, and Google to identify national and international guidelines on maternal sepsis. In addition, 2 focused literature searches were performed: one targeting maternal sepsis review articles and the other exploring early warning tools for maternal sepsis. Recognizing that maternal sepsis occurs in the outpatient and inpatient settings, we emphasize the need for early detection in both settings. We introduce a 3-stage screening and diagnostic framework along with a care process model for the initial management of maternal sepsis, both grounded in best practices and designed to align with CMS guidance. In addition, alternative regimens for treating peripartum infections are suggested in light of the recent Clinical and Laboratory Standards Institute updates on aminoglycosides. Strategies for managing β-lactam allergies are also explored, offering tailored treatment regimens for patients with varying allergic reactions. The article concludes by highlighting the long-term impact of sepsis and the critical need for comprehensive postdischarge follow-up to ensure optimal recovery.