Incidence, Etiology and Trimester Specific Fetal Outcomes of Maternal Sepsis in Pregnancy: A Prospective Hospital Based Study

Abstract

Background and Aims: Maternal sepsis remains a significant cause of maternal and fetal morbidity and mortality, particularly in developing countries. This prospective hospital-based study aimed to evaluate the incidence, etiology, and trimester-specific fetal outcomes associated with maternal sepsis. Methodology: The study was conducted over a two-year period (21st March 2020 to 20th March 2022) in a tertiary care maternity and neonatology center. All pregnant and postpartum women diagnosed with maternal sepsis were included. Blood cultures were performed to identify causative organisms, and antibiotic susceptibility testing was carried out according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: A total of 2011 pregnant women were evaluated, among whom 424 cases of laboratory-confirmed maternal sepsis were identified. Ten different microbial species were isolated. Escherichia coli was the most common pathogen (38.68%), followed by Pseudomonas aeruginosa (21.7%) and Klebsiella pneumoniae (21.23%). The highest number of infections occurred during the postpartum period. Fetal outcomes varied significantly with gestational age at the onset of sepsis. In the first trimester, 56.25% of cases resulted in miscarriage, with no neonatal deaths or stillbirths. The second trimester showed the highest adverse outcomes, with 72.16% miscarriages and 5.15% neonatal deaths. In contrast, third trimester sepsis was associated with improved outcomes, with 95.17% live births, 0.9% neonatal deaths, and 3.86% stillbirths. Overall, fetal loss occurred in 18.63% of cases. Conclusion: No direct maternal deaths were observed; however, one indirect maternal death was associated with COVID-19 infection. Maternal sepsis, particularly in early pregnancy, is strongly associated with adverse fetal outcomes, highlighting the importance of early diagnosis and timely management.