Key takeaways:
- Most patients who died had recent health care contact outside of obstetric settings, highlighting the need for cross-disciplinary sepsis recognition training and standardized referral pathways in emergency departments, urgent care, and pediatric offices.
- Racial and geographic disparities in infection-related maternal deaths point to structural barriers requiring system-level interventions, including expanded postpartum telemedicine and community-based care options.
- Clinicians across settings should maintain a high index of suspicion for sepsis in recently pregnant patients, as classic signs may be absent and symptoms may overlap with normal postpartum physiology.
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.
