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

If they meet any high risk criteria, refer people with suspected sepsis who are or were recently pregnant and are outside acute hospital settings for emergency medical care (see table 1: criteria for stratification of risk from sepsis in people who are or have recently been pregnant).

Use the most appropriate means of transport (usually 999 ambulance).

Emergency care requires facilities for resuscitation to be available and, depending on local services, may be an emergency department, medical admissions unit or maternity services. [2016]

Pre-alert secondary care (through GP or ambulance service) when any high risk criteria are met in a person with suspected sepsis who is or has recently been pregnant and is outside of an acute hospital, and transfer the person immediately. [2016]

In remote and rural locations where transfer time to emergency department is routinely more than 1 hour, ensure GPs have mechanisms in place to give antibiotics to people with suspected sepsis who are or have recently been pregnant and meet high risk criteria in pre-hospital settings. For high risk criteria, see table 1: criteria for stratification of risk from sepsis in people who are or have recently been pregnant. [2016, amended 2024]

In remote and rural locations where combined transfer and handover times to emergency department are greater than 1 hour:

• ambulance services should consider whether they need to put mechanisms in place to be able to give antibiotics to people with high risk criteria if antibiotics have not been given before by a GP (for high risk criteria, see table 1: criteria for stratification of risk from sepsis in people who are or have recently been pregnant)

• paramedics who are thinking about giving antibiotics should follow local guidelines or seek advice from more senior colleagues, if needed. [2016, amended 2024]
  
  See also the recommendations on choice of antibiotic therapy for people with suspected sepsis.

Assess people with suspected sepsis who are or have recently been pregnant, are outside acute hospital settings, and meet any moderate to high risk criteria to:

• make a definitive diagnosis of their condition

• decide whether their condition can be treated safely outside hospital.
  
  If a definitive diagnosis is not reached or the person's condition cannot be treated safely outside an acute hospital setting, refer them urgently for emergency care. [2016]

If a person with suspected sepsis who is or has recently been pregnant does not meet any high risk or moderate to high risk criteria, provide the person with information about:

• symptoms to monitor and

• how to access medical care if they are concerned.
  
  Also see information at discharge for people assessed for suspected sepsis, but not diagnosed with sepsis. [2016]

For people in hospital who have suspected infections:

• start looking for the source of infection (see the section on finding and controlling the source of infection)

• take microbiological and blood samples before giving an antimicrobial.
  
  See the UK standards for microbiology investigations. [2016, amended 2024]

For people with suspected sepsis who are or have recently been pregnant and either meet 2 or more moderate to high risk criteria or have systolic blood pressure 91 to 100 mmHg:

• carry out a venous blood test, including for:

  • blood gas, including glucose and lactate measurement

  • blood culture

  • full blood count

  • C-reactive protein

  • urea and electrolytes

  • creatinine

  • liver function tests

  • a clotting screen

• arrange for a clinician to review the person's condition and venous lactate results within 1 hour of meeting 2 or more moderate to high risk criteria or have systolic blood pressure 91 to 100 mmHg.
  
  A 'clinician' should be a medically qualified practitioner or equivalent who has antibiotic prescribing responsibilities. [2016, amended 2024]

For people with suspected sepsis who are or have recently been pregnant, meet 2 or more moderate to high risk criteria and have either lactate over 2 mmol/litre or evidence of acute kidney injury, treat their condition as if it met 1 or more high risk criteria.

For a definition of acute kidney injury, see NICE's guideline on acute kidney injury. [2016]

For people with suspected sepsis who are or have recently been pregnant, meet 2 or more moderate to high risk criteria, have lactate of 2 mmol/litre or lower, have no evidence of acute kidney injury, and in whom a definitive condition cannot be identified:

• repeat structured assessment at least hourly

• ensure a senior clinical decision maker reviews the person's condition and need for antibiotics within 3 hours of meeting 2 or more moderate to high risk criteria. [2016]

For people with suspected sepsis who are or have recently been pregnant and meet only 1 moderate to high risk criterion:

• arrange for clinician review within 1 hour of meeting a moderate to high risk criterion

• perform blood tests if indicated.
  
  A 'clinician' should be a medically qualified practitioner or equivalent who has antibiotic prescribing responsibilities. [2016]

For people with suspected sepsis who are or have recently been pregnant, meet only 1 moderate to high risk criterion, have lactate of less than 2 mmol/litre, have no evidence of acute kidney injury, and in whom a definitive condition cannot be identified:

• repeat structured assessment at least hourly

• ensure a senior clinical decision maker reviews the person's condition and need for antibiotics within 3 hours of meeting moderate to high risk criterion. [2016]

For people with suspected sepsis who are or have recently been pregnant and meet no high risk or moderate to high risk criteria:

• arrange for clinician review

• use clinical judgement to manage their condition.
  
  A 'clinician' should be a medically qualified practitioner or equivalent who has antibiotic prescribing responsibilities. [2016]

Before discharging people who have been assessed for suspected sepsis, provide information on:

• the management of their definitive condition (if identified) and

• warning signs for sepsis (see information at discharge for people assessed for suspected sepsis). [2024]