Maternal sepsis is life-threatening organ dysfunction brought on by infection during pregnancy, childbirth, abortion, or the time after delivery. The source can be pyelonephritis, chorioamnionitis or an intra-amniotic infection, endometritis, a wound infection, pneumonia, retained products, or something entirely outside obstetrics. Importantly, fever may be absent, especially early on or in a patient who's already quite sick.
When I review these cases, I'm not looking at isolated numbers — I'm tracking trends. Mental status, urine output, oxygen needs, blood pressure, lactate, kidney and liver function, platelets, culture results, fetal status, and how the patient responded to fluids and antibiotics. I want to know when infection was first suspected, when organ dysfunction started to show, when cultures and antibiotics were ordered and actually given, and whether source control and a higher level of care were pursued once things weren't improving.
On the plaintiff side, the theory often centers on delayed recognition — anchoring on a diagnosis that seemed benign, not responding to repeated calls or concerns, antibiotics that came too late, or escalation that didn't happen quickly enough. On the defense side, the record may show an atypical presentation that was genuinely hard to catch early, rapid progression despite good care, appropriate empiric therapy chosen at the time, timely source control, or an injury that occurred even though the care followed accepted guidelines. Antibiotic selection should be evaluated based on the information reasonably available at the time — the likely source, allergies, local protocols, resistance patterns — not by working backward from whatever the culture eventually showed.
Sepsis cases are also, at their core, systems cases. Triage pathways, handoffs between providers, early warning triggers, how fast the lab turned results around, pharmacy access, when consultations happened, transfer capacity — all of this can shape the timeline just as much as any single decision at the bedside. A good expert has to be able to explain both the obstetric physiology and the operational realities that the chart actually reflects.
Questions for Counsel
- What vital sign abnormalities were present prior to the recognition of sepsis, and were they documented and responded to in a manner consistent with the facility's maternal early warning criteria?
- Were blood cultures obtained before antibiotics were administered, and how long after recognition of infection was antibiotic therapy initiated?
- Was the antibiotic regimen appropriate for the likely source — chorioamnionitis, postpartum endometritis, or urinary source — and was it adjusted in a timely manner based on culture results?
- Was source control addressed — including delivery decision timing in chorioamnionitis — and was the clinical deterioration temporally linked to a failure to pursue source control?
- Was the maternal sepsis safety bundle adopted by this facility, and does the medical record reflect compliance with each bundle element in this case?
Disclaimer: This material is for general educational purposes and does not constitute legal advice, medical advice, or a case-specific standard-of-care or causation opinion. Clinical guidance changes over time. Every matter requires review of the complete record, applicable guidance in effect on the date of care, local resources, and jurisdiction-specific legal standards. For consultation on a specific case, contact OBGYN Peer.