Life-threatening infections in pregnancy

Sepsis as a clinical manifestation of a life-threatening infection is one of the leading causes worldwide of maternal mortality in pregnancy and childbirth. The rapid recognition of sepsis and initiation of treatment with intravenous fluids and antibiotic therapy is crucial in the management of sepsis. Vasopressors should be administered in cases of persisting hypotension. A close fetomaternal surveillance is crucial. A chorioamnionitis is an indication for delivery. Administration of steroids for induction of fetal lung maturation is not contraindicated in cases of sepsis. The definition of sepsis and its management are similar to those in nonpregnant individuals. The sequential organ failure assessment (SOFA) score is used for assessment of organ dysfunction. The most frequent causes of sepsis in pregnancy are chorioamnionitis, pyelonephritis and an exacerbated respiratory tract infection. Pregnant women are particularly prone to severe disease progression due to immunological and adaptive changes in respiratory physiology during pregnancy. Appendicitis-related sepsis is rare; however, as the diagnosis of appendicitis in pregnancy is often delayed perforation occurs more frequently and then leads to sepsis. Diseases that are rare in Germany (for example malaria) need to be considered in patients with fever and an appropriate history (e.g., travelling).