A Multicenter Study in Northern Italy to Evaluate the Impact of a Sepsis Bundle in Obstetric Settings: The SOS Study

Category	Detail
Condition	Maternal sepsis during pregnancy and puerperium
Key Mechanisms	Early identification and management of sepsis using a regional sepsis management bundle tailored for obstetric patients
Target Population	Pregnant and puerperal adult women diagnosed with sepsis
Care Setting	Obstetric care in referral hospitals with ICU, infectious diseases, gynecology/obstetrics, pediatric, and neonatology services

Implementation of a regional maternal sepsis management bundle did not significantly change maternal mortality or length of hospital stay.
Neonatal intensive care unit admissions significantly decreased postbundle implementation (from 85.7% to 31.3%).
Infectious disease specialist consultations increased significantly after bundle implementation (from 50.0% to 75.0%), indicating improved sepsis awareness.

Use Surviving Sepsis Campaign guidelines adapted for obstetric patients to identify sepsis.
Apply organ dysfunction criteria with an increase of ≥2 points in SOFA score.
Consider clinical suspicion supported by signs, symptoms, radiologic and microbiologic data.

Implement a standardized sepsis management bundle specific to obstetric patients.
Increase involvement of infectious disease specialists in sepsis cases.
Follow regional risk management protocols for early diagnosis and treatment.

Monitor maternal clinical outcomes including length of stay and organ dysfunction.
Track neonatal outcomes, particularly NICU admissions.
Evaluate process measures such as frequency of infectious disease consultations.

Delayed recognition of sepsis due to altered physiologic and immunologic responses in pregnancy.
Limitations of general sepsis scoring systems (qSOFA, NEWS, SIRS) in pregnant populations.
Uncertainty about the direct impact of bundle implementation on neonatal outcomes.

Pregnant and puerperal adult women diagnosed with sepsis in 7 hospitals in Lombardy, Italy

Postbundle period showed increased infectious disease consultations and reduced neonatal ICU admissions, though maternal outcomes remained unchanged.

Adopt obstetric-specific sepsis scoring systems such as the Modified Early Obstetric Warning Score (MEOWS) alongside management bundles.
Ensure early involvement of infectious disease specialists to enhance sepsis recognition and treatment.
Implement standardized sepsis bundles tailored to the obstetric population to improve process measures and potentially neonatal outcomes.
Maintain multidisciplinary care involving obstetrics, infectious diseases, neonatology, and intensive care units.

Clinical Scorecard: Evaluation of a Sepsis Management Bundle in Obstetric Care: Findings from a Multicenter Study in Northern Italy