Most maternal infection deaths occur after a recent clinical encounter

Improving postpartum surveillance, expanding access to care beyond traditional clinical settings, and training providers across specialties to recognize sepsis are among the most actionable steps to reduce pregnancy-related deaths from infection, according to Naima T. Joseph, MD, MPH, whose analysis of Maternal Mortality Review Committee (MMRC) data from 29 states was previously reported in part.¹

A central finding from that analysis—that 69.1% of decedents had a health care encounter within 7 days of death—carries significant implications for how clinicians approach postpartum follow-up. Joseph emphasized that many patients did not return to their obstetrician, but presented elsewhere.

"Patients may not present to their OBs, but will present to many different other facilities, including emergency departments, urgent care visits, and even their child's pediatrician," she said. "That suggests a role for interdisciplinary care protocols that can enhance provider recognition as well as referral pathways that can diminish burden on patients to seek care but improve their ability to access care where they are."

The racial and geographic disparities seen in the data—with Black and Hispanic patients disproportionately affected and a higher burden of deaths in urban locations—point to structural drivers that extend beyond individual clinical encounters. Joseph noted that many of the MMRC recommendations focused on reducing delay across patient, community, and provider levels. Expanding postpartum touchpoints through telemedicine visits, mobile health clinics, and telephone check-ins may help reach patients who face barriers to traditional follow-up.

The diagnostic challenge of pregnancy-related sepsis compounds these access issues. Joseph stressed that the overlap between normal physiologic changes in pregnancy and early sepsis signs—including tachycardia and leukocytosis—demands a sustained high index of suspicion. "All people must maintain a high index of suspicion for infection and evaluate accordingly," she said. Fever, while a classic sepsis marker, may be absent in pregnant and recently pregnant patients, making clinical vigilance especially important.

Broadening the differential diagnosis at every point of contact is critical, she added. Patients presenting with abdominal pain or fever should be asked about recent pregnancy regardless of how that pregnancy ended.

"They are given tools to receive a complete evaluation, including pelvic exams when indicated, and the differential diagnosis is broadened to include those that could be pregnancy complications," Joseph said.

Continuing education across specialties was a recurring theme in the MMRC recommendations. Joseph called for all health professionals who may care for pregnant or recently pregnant women to receive training in sepsis recognition and management, with access to cross-disciplinary support structures. This is particularly relevant given that the genital tract was the most frequently identified infection source and group A streptococcus the most common pathogen—findings that underscore the need for familiarity with obstetric-specific infection patterns well beyond the labor and delivery unit.

REFERENCE

1. Joseph NT, Trost SL, Hollier LM, et al. Pregnancy-related mortality due to infection: maternal mortality review committees in 29 U.S. States, 2017-2019. Obstet Gynecol. 2026 Jan 9. doi:10.1097/AOG.0000000000006172