Burden of sepsis in obstetric critically ill patients: A qualitative systematic review

Sepsis is a major contributor to maternal morbidity and mortality worldwide and represents one of the leading causes of intensive care unit (ICU) admission among obstetric patients. However, the burden and clinical profile of the most severely affected women remain incompletely defined. This systematic review aimed to estimate the epidemiology, characteristics, and outcomes of sepsis in critically ill obstetric patients.

A comprehensive search was conducted for studies published between 2013 and 2025, including studies of women requiring ICU admission for sepsis during pregnancy or the post-partum. Following the screening process, 25 of the 5847 screened studies met the inclusion criteria. All were observational. The overall population included 7,434,710 hospitalised obstetric patients, including 3,593 obstetric ICU admissions for sepsis. The incidence of intensive care unit admissions ranged from 21 to 857 every 10,000 hospitalized obstetric patients and reached incidences of 11.3% among hospitalized obstetric patients with sepsis. Sepsis accounted for 5.7% of obstetric ICU admissions.

Half of the patients had one organ dysfunction, while a quarter had three or more, with respiratory and cardiovascular insufficiencies being the most common. The main infection sources were the genital, respiratory, and urinary tracts. Septic shock occurred in 16.6% of the cases. The mean Sequential Organ Failure Assessment (SOFA) score was 6.2 and the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score was 12.3. ICU and hospital stay were 3 and 8 days. Mortality varied significantly (median 4.6%), with marked disparities between high- and low-income countries.

Robust epidemiological monitoring is therefore urgently required.

PROSPERO under ID 2023 CRD42023446466.