* One study found only 18% of women who died of sepsis were febrile on presentation and 25% never developed a fever at all [6].

The positive predictive value of an early warning system would be expected to be improved when applied to a population with a high prevalence of the condition being screened for.
 

Risk factors for the development of or progression to severe sepsis in pregnancy [2, 3,4] • Women who have had a febrile illness or have been taking antibiotics 2 weeks prior to presentation • Prolonged spontaneous rupture of membranes • Chronic hypertension, preeeclamspia postpartum hemorrhage • Obesity • Impaired glucose tolerance / diabetes • Anemia • Impaired immunity/ immunosuppressant    medication • Vaginal discharge • Cesarean section • History of pelvic infection • Operative vaginal delivery • History of group B streptococcal infection • Multiple birth • Amniocentesis and other invasive procedures • Being primiparous • Cervical cerclage • Being black or from an other minority ethnic    group • Group A streptococcus (GAS) infection in close contacts / family members The two most common organisms identified in women dying of peripartum sepsis have been reported to be E coli. and  group A streptococcus (GAS) [2,5,6] In cases of suspected bacterial sepsis, when the source of infection is unclear , the Royal College of Obstetricians and Gynaecologists recommends ,empirically, broad spectrum antimicrobials active against Gram-negative bacteria, and capable of preventing exotoxin production (e.g. clindamycin) * from Gram-positive bacteria such as GAS , should be used , and therapy narrowed once the causative organism(s) has been identified [2] REFERENCE: 1.Albright CM, et. al., The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. 2014 Jul;211(1):39.e1-8. doi: 10.1016/j.ajog.2014.03.010. Epub 2014 Mar 12. PMID: 24613756 2. Bacterial Sepsis in Pregnancy RCOG Green-top Guideline No. 64a. Royal College of Obstetricians and Gynaecologists, 2012 https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_64a.pdf 3. Levy MM, Dellinger RP, Townsend SR, et al; Surviving Sepsis Campaign: The Surviving Sepsis Campaign: Results of an internationalguideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010; 38:367–374 4. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al.. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580–637. http://www.sccm.org/Documents/SSC-Guidelines.pdf 5. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012 Sep;120(3):689-706. doi: 10.1097/AOG.0b013e318263a52d. Review. Erratum in: Obstet Gynecol. 2012 Nov;120(5):1214. PMID:22914482 6. Bauer ME, et. al., Maternal Deaths Due to Sepsis in the State of Michigan, 1999-2006. Obstet Gynecol. 2015 Oct;126(4):747-52. PMID: 26348189 7. Albright CM, et. al., Obstet Gynecol. 2017 Oct;130(4):747-755. Internal Validation of the Sepsis in Obstetrics Score to Identify Risk of Morbidity From Sepsis in Pregnancy. PMID: 288854007. All calculations must be confirmed before use. The suggested results are not a substitute for clinical judgment. Neither Perinatology.com nor any other party involved in the preparation or publication of this site shall be liable for any special, consequential, or exemplary