Maternal deaths from sepsis in the Nordic countries during 2005-2021: A descriptive study.

Introduction: Maternal sepsis is a heterogenous condition which can arise from several different infections during and after pregnancy. Common for all etiologies is a high mortality rate. In a global perspective, maternal sepsis is an important contributor to maternal death. This study aimed to evaluate the clinical management of maternal deaths from sepsis in the Nordic countries and identify areas for improved clinical handling.

Material and methods: We used data from the Nordic Maternal Mortality Collaboration including maternal deaths from the five Nordic countries from 2005 till 2021, identified through linked registers. The national audit groups assessed each maternal death based on hospital records and classified it according to cause and quality of management. We formulated learning points to improve future clinical care in cases of maternal sepsis.

Results: In total, 267 maternal deaths were identified, equaling a maternal mortality rate of 5.9 per 100 000 live births (95% CI 5.25-6.62). Maternal sepsis accounted for 9.7% of the maternal deaths (n = 26), ranking sepsis the fifth leading cause. Nongenital sepsis and genital tract sepsis numbers were almost equal. Substandard care was identified in 57% of cases with nongenital infections, and in 83% of genital tract sepsis cases. Improvements in care that possibly could have influenced the outcome were noted in 29% and 67% of cases, respectively. In nongenital sepsis, delayed recognition of sepsis and delayed administration of antimicrobial therapy were the commonest elements in substandard care. Delayed recognition of sepsis, delayed administration of antimicrobial therapy, and postponed or lacking surgical source control were the main elements in substandard care of genital tract sepsis.

Conclusions: In the Nordic countries, sepsis was the fifth leading cause of maternal deaths during 2005-2021. In one-third of maternal deaths from nongenital sepsis and two-thirds of maternal deaths from genital tract sepsis, clinical measures could have reduced the risk of fatal outcome, emphasizing the need for maximal awareness and improved clinical handling.