Presented September 3, 2025 at the 2025 APSF Stoelting Conference on “Transforming Maternal Care: Innovations and Collaborations to Reduce Morbidity and Mortality”
SUMMARY
Emily Naoum, MD’s presentation focuses on the critical issue of Maternal Sepsis, which contributes to a substantial portion of severe maternal morbidity and mortality, remaining the third to fifth leading cause of maternal death in various reports. The primary challenge is the difficulty in early identification, as normal pregnancy physiology mimics early signs of sepsis, and up to a quarter of fatal cases may never present with a fever. The key message is the urgent need for early recognition using pregnancy-specific screening tools like the Maternal Early Warning System (MEWS), followed by immediate, systematic management, with the goal of administering targeted antibiotics within one hour to improve patient outcomes and close the care gap.
Key Points:
- Significant Mortality Contributor
Sepsis is responsible for 10-15% of all maternal deaths and contributes to up to a quarter of maternal ICU admissions, with rates remaining largely unchanged over the past decade [02:33, 02:56]. - Diagnostic Challenge in Pregnancy
Standard Sepsis Scoring Tools (e.g., SIRS, qSOFA) perform poorly in pregnant patients because normal pregnancy physiology (e.g., vasodilation, increased heart rate) mimics early signs of sepsis [05:19, 05:27]. - High Risk of Missed Diagnosis
Delayed recognition is directly linked to increased mortality. In one study of fatal cases, less than one in five women were febrile upon presentation, and a quarter never developed a fever, necessitating a high index of suspicion [05:59, 06:13]. - Required System-Level Intervention
Maternal Early Warning Systems (MEWS) coupled with prescribed clinical pathways significantly reduce severe maternal morbidity by standardizing notification, intervention, and management within the first hour [08:18, 08:40]. - Time-Sensitive Treatment
Antibiotic administration within one hour is critical; however, retrospective studies show only 10-13% of patients receive antibiotics within this essential timeframe, highlighting a critical area for improvement [10:13, 11:13].
ABOUT THE SPEAKER(S)
Emily Naoum, MD
Obstetric Anesthesiologist and Critical Care Physician,
Massachusetts General Hospital
Program Director of Obstetric Anesthesiology Fellowship
Assistant Professor,
Harvard Medical School
Emily Naoum attended undergraduate and medical school at the University of Michigan before residency in Anesthesiology at Massachusetts General Hospital. She then completed Obstetric Anesthesia and Critical Care fellowships at the University of Michigan. She is an Assistant Professor at MGH and Harvard Medical School and serves as the Program Director of the Obstetric Anesthesia fellowship. She is an active member of the Society of Critical Care Medicine, Society of Critical Care Anesthesiologists, Society for Obstetric Anesthesia and Perinatology, and Extracorporeal Life Support Organization. She practices a mix of obstetric anesthesia, surgical critical care, and general anesthesia and has research interests in extracorporeal life support in pregnancy, maternal critical illness, and cardiovascular critical care.
