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Calculate Sepsis in Obstetrics Score

Severe sepsis with acute organ dysfunction has a mortality rate of up to 40%, which increases to 60% if septic shock develops. Early recognition of sepsis and implementation of evidence-based therapies have been documented to improve outcomes and decrease sepsis-related mortality.

The Sepsis in Obstetrics Score (S.O.S.) was created by modifying validated scoring systems in accordance with recognized physiologic changes of pregnancy.

“The Sepsis in Obstetrics Score is a validated pregnancy-specific score to identify risk of ICU admission for sepsis, with the threshold score of 6 having a negative predictive value of 98.6%. A score of less than 6 rules out the need for ICU admission.”

Risk factors for the development of or progression to severe sepsis in pregnancy

• Women who have had a febrile illness or have been taking antibiotics 2 weeks prior to presentation
• Chronic hypertension, preeclampsia, postpartum hemorrhage
• Impaired glucose tolerance / diabetes
• Impaired immunity / immunosuppressant medication
• Cesarean section
• Operative vaginal delivery
• Multiple birth
• Being primiparous
• Being black or from another minority ethnic group
• Prolonged spontaneous rupture of membranes
• Obesity
• Anemia
• Vaginal discharge
• History of pelvic infection
• History of group B streptococcal infection
• Amniocentesis and other invasive procedures
• Cervical cerclage
• Group A streptococcus (GAS) infection in close contacts / family members

The two most common organisms identified in women dying of peripartum sepsis have been reported to be E. coli and Group A streptococcus (GAS).

Empiric antibiotic considerations

In cases of suspected bacterial sepsis, when the source of infection is unclear, the Royal College of Obstetricians and Gynaecologists recommends that empirically, broad-spectrum antimicrobials active against Gram-negative bacteria, and capable of preventing exotoxin production (e.g., clindamycin) from Gram-positive bacteria such as GAS, should be used, and therapy narrowed once the causative organism(s) has been identified.