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News / Understanding Maternal Sepsis: Insights From a Maternal-Fetal Medicine Specialist 

Understanding Maternal Sepsis: Insights From a Maternal-Fetal Medicine Specialist 

Published Jan 2, 2025

Amanda Trudell, D.O., MSCI 

As a maternal-fetal medicine specialist, my work is a blend of dedication, expertise and compassion. After completing my residency and board certification in obstetrics and gynecology, I pursued an additional three-year fellowship in MFM, while simultaneously completing a Master of Science in Clinical Investigation. This journey equipped me with specialized training in managing high-risk pregnancies, addressing complications and conducting advanced obstetric ultrasounds. 

Today, I practice as a full-time clinical MFM specialist in St. Louis, working for BJC Medical Group at Missouri Baptist Medical Center. My role spans a wide geographic area, serving patients in eastern Missouri and southwestern Illinois. In addition to my clinical work, I am the Director of MFM Program Development at MoBap and contribute to women’s and infants quality improvement initiatives within the BJC system. It’s a role I cherish deeply, supported by an incredible team and fueled by a passion for serving my community. Outside of work, I am the proud mother of two little girls, ages 9 and 5, who bring light and love to my life. 

One of the most critical challenges I encounter is maternal sepsis — a condition that requires early recognition, prompt treatment and compassionate care. 

Understanding Maternal Sepsis

Sepsis is not a specific illness but a syndrome with complex and not fully understood biology. Defined in 2016 by the Third International Consensus Definitions for Sepsis and Septic Shock, sepsis is “life-threatening organ dysfunction caused by a dysregulated host response to infection.” Simply put, it is an unchecked inflammatory response to infection that leads to a cascade of events causing organ damage. In severe cases, this can progress to septic shock, marked by dangerously low blood pressure and further organ failure. 

In pregnancy, the most common infections associated with sepsis include the following. 

  • Chorioamnionitis: Infection of the amniotic sac 
  • Septic abortion 
  • Postpartum infections: Such as endometritis (infection of the uterine lining) and wound infections 

Nonobstetric infections like urinary tract infections, pneumonia, appendicitis or other gastrointestinal conditions also can lead to sepsis. Symptoms such as fever, chills, low urine output, changes in mental status, easy bruising, difficulty breathing or low blood pressure (especially systolic BP < 100 mmHg) warrant immediate medical evaluation. 

Barriers to Diagnosis

Diagnosing maternal sepsis is challenging due to the physiological changes of pregnancy. Normal pregnancy changes, such as lower blood pressure, increased heart rate, respiratory rate and elevated white blood cell counts, can overlap with signs of sepsis. Additionally, pregnancy alters kidney function, making serum creatinine levels less sensitive as a marker of kidney injury. 

These factors can delay diagnosis and treatment, increasing the risk of severe outcomes. Early recognition and timely intervention, including antibiotic therapy and supportive care in an intensive care setting, are crucial to improving outcomes. 

Prevention Strategies

While preventing sepsis entirely is difficult, certain measures can reduce risk. 

  • Early Identification and Treatment of Infections 
    • Attend regular prenatal checkups. 
    • Address concerns about infections, such as UTIs, promptly by consulting your obstetrician. 
  • Primary and Dental Care 
    • Seek care for common illnesses like strep throat or pneumonia. 
    • Maintain routine dental hygiene to prevent infections from spreading via the bloodstream. 
    • Address dental abscesses with necessary surgical interventions during pregnancy to improve outcomes. 
  • Proactive Measures During Delivery 
    • Preoperative antibiotics before cesarean delivery significantly reduce infection risks at the wound site and within the uterus. 

Supporting Survivors of Maternal Sepsis

Recovering from sepsis can be a physically and emotionally daunting journey. Survivors may experience post-traumatic stress disorder, making empathetic support and counseling essential. Families and care providers who witness such events also may benefit from counseling to cope with the trauma. 

Online support groups offer a space for connection, understanding and healing. Listening with empathy can provide immense comfort to those navigating the aftermath of this challenging condition. 

Conclusion

As an MFM specialist, my mission is to improve maternal outcomes through education, early intervention and compassionate care. Maternal sepsis, though daunting, is a challenge that can be addressed through vigilance, awareness and teamwork. Together, we can ensure healthier pregnancies and brighter futures for mothers and their families. 

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