The word “sepsis” is inextricably linked in many people’s minds to the shocking death of Savita Halappanavar (31) in University Hospital Galway in 2012.
She died of septicaemia in the 17th week of her pregnancy and an HSE review identified multiple failures in the assessment and monitoring of her condition. Reluctance of clinical staff to intervene until the foetal heartbeat stopped was also highlighted and public outrage about her death gave momentum to the push for new abortion legislation, which was introduced in 2018.
The number of cases of septicaemic shock reported to the National Perinatal Epidemiology Centre, increased sharply in the wake of Halappanavar’s death, and that was attributed to increased awareness. Its latest report, for 2020, shows that of the 329 women who had very serious maternal complications, known as severe maternal morbidities, 16 had septicaemic shock. (The leading cause of severe complications is major obstetric haemorrhage, accounting for 55 per cent.)
The problem is always recognising sepsis, as it presents in so many different ways, says Prof Mary Higgins, consultant obstetrician and gynaecologist at the National Maternity Hospital in Dublin. The HSE is using September, Sepsis Awareness Month, to alert the public to the signs of sepsis, for which 12,000 people were treated in Irish hospitals last year. Approximately one in five die from the condition.
Pregnant women and new mothers may develop sepsis due to obstetric or non-obstetric causes. It will start with an infection, which could be anything from flu or a urinary tract infection to E-coli bacteria getting in, say, after the waters have broken, as happened in Halappanavar’s case. Infections are common; developing sepsis as a result is less common, and septic shock is uncommon, says Higgins.
“Sepsis is where your body is reacting to infection: your heart rate is going high, blood pressure going down, temperature going high, you’re becoming unwell. Septic shock is where your blood pressure is down despite resuscitation – this is showing you’re becoming incredibly sick.”
There’s a principle in treatment of sepsis known as the “golden hour”, in which you have an hour or two to stop them getting sick, she says. Health professionals are drilled in the “sepsis six” methods of management and in maternity hospitals that is “sepsis six plus one” – the one being think of the baby.
In pregnancy, a woman is carrying a baby that is 50 per cent genetic material that is foreign to her body. Instead of rejecting it, her immunity changes to support the pregnancy, explains Higgins, but if she gets an infection, she is more likely to get sick with that infection. There are physical changes too that contribute to the risk, such as the heart being under more stress in pumping blood to the baby and the lungs physically compromised by the growing foetus. It can get to the point where the baby has to be delivered to give the woman’s body a fighting chance to recover from sepsis.
“It’s a relatively easy decision to make when someone’s over 37 weeks but much more challenging between 24 and 36 weeks,” she says. “It’s a real question of: is there anything else we can do to get her through this so she will recover herself and avoid prematurity. It’s more challenging again – though easier since the referendum and [2018] Act – if somebody is under 24 weeks, as it means ending the pregnancy and the baby not surviving.”
Could it be sepsis?
The most commonly reported symptoms of sepsis include:
- Slurred speech, mild agitation, confusion, “not feeling right”
- Extreme aches and pains in joints; temperature of 38 degrees and higher
- P Have not passed urine in last 12 hours? No urge to pass urine?
- Short of Breath. Can you finish a sentence without pause? Are your lips tinged with blue? Is your heart racing very fast? Are you persistently dizzy when you sit or stand up?
- I feel like I’m going to die
- Skin appears mottled, blueish in colour or new red rash that is still visible when pressed on by your finger or glass (glass test).
(Source: Health Service Executive)
