Suspected sepsis in pregnant or recently pregnant people: recognition, diagnosis and early management

  • NICE guideline
  • NG255
  • Published: 

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Could this be sepsis?

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

1.1 When to suspect sepsis

1.1.1

Think 'could this be sepsis?' if a person presents with symptoms or signs that indicate possible infection. [2016]

1.1.2

Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature. [2016]

1.1.3

Pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour. [2016]

1.1.4

Assess people who might have sepsis with extra care if there is difficulty in taking their history, for example people with English as a second language or people with communication difficulties (such as learning disabilities or autism). [2016, amended 2024]

1.1.6

During a remote assessment, when deciding whether to offer a face-to-face-assessment and, if so, on the urgency of it, identify:

  • factors that increase risk of sepsis (see people who are most vulnerable to sepsis) and

  • indications of clinical concern such as new-onset abnormalities of behaviour, circulation or respiration. [2016]

1.1.8

Consider using an early warning score to assess people with suspected sepsis who are pregnant or have recently been pregnant, in any setting. [2016, amended 2024]

1.1.9

Suspect neutropenic sepsis in people who become unwell and:

  • are having or have had systemic anticancer treatment within the last 30 days

  • are receiving or have received immunosuppressant treatment for reasons unrelated to cancer. Use clinical judgement (based on the person's specific condition, medical history, or both, and on the treatment they received) to determine whether any past treatment may still be likely to cause neutropenia. [2016, amended 2024]

1.2 People who are most vulnerable to sepsis

1.2.1

Take into account that people who are pregnant, have given birth or had a termination of pregnancy or miscarriage in the past 6 weeks are in a high risk group for sepsis. In particular, people who:

  • have impaired immune systems because of illness or drugs (see recommendation 1.2.2)

  • have diabetes, gestational diabetes or other comorbidities

  • needed invasive procedures (for example, caesarean section, forceps delivery, removal of retained products of conception)

  • had prolonged rupture of membranes

  • have or have been in close contact with people with group A streptococcal infection, for example, scarlet fever

  • have continued vaginal bleeding or an offensive vaginal discharge. [2016]

1.2.2

Take into account the factors that may increase the risk of developing sepsis or sepsis not being identified promptly. These include:

  • ethnicity: being from an ethnic minority background

  • clinical features such as:

    • frailty

    • multimorbidities or severe chronic conditions

    • impaired immune function because of illness or medical treatment

    • surgery or invasive procedures in the past 6 weeks

    • indwelling catheters

    • repeated antibiotic use

    • breach of skin integrity

  • communication difficulties, such as with people:

    • with learning difficulties

    • with cognitive impairment

    • who need an interpreter

  • drugs or alcohol misuse

  • social, economic or environmental factors such as: