Disclosure(s): No relevant financial relationship(s) to disclose.
Introduction: Maternal sepsis remains a leading cause of pregnancy-related mortality in the U.S. We hypothesized that delivery-associated infections, demographic and clinical risk factors, and social vulnerability would predict sepsis, ICU utilization, and in-hospital mortality during delivery hospitalizations.
Methods: A retrospective cohort study of 4.29 million delivery hospitalizations (01/2022-03/2025; 15-54) was conducted using the Vizient® Clinical Data Base. Sepsis, infections (e.g., pneumonia/influenza, endometritis, chorioamnionitis), and comorbidities were identified using ICD-10-CM codes. Multivariable logistic regressions evaluated associations between demographic/clinical factors, including age, race/ethnicity, payer, delivery mode, and ZIP code level vulnerability using the Vizient Vulnerability Index™ (VVI), and three outcomes: sepsis among all deliveries, and ICU use and mortality among those with sepsis.
Results: Sepsis occurred in 0.2% (n=7,771; 18.1 per 10,000) of delivery hospitalizations. Significant predictors of sepsis included age 40+ (OR 1.2), Asian (OR 1.7) and Black race (OR 1.5), Medicaid (OR 1.4), and cesarean delivery (OR 2.1). ICU utilization occurred in 20% of sepsis cases and was associated with cesarean delivery, age ≥35, Medicaid, and high VVI among those with sepsis. In-hospital mortality at the delivery encounter among those with sepsis was 0.8% (compared to 0.01% without sepsis), with similar predictors. Pneumonia/influenza showed an upward seasonal trends with a peak in early 2025, while both endometritis and chorioamnionitis trends increased across the study period; all strongly associated with sepsis. Median hospital length of stay was 7.4 days among sepsis cases, compared to 2.7 days without sepsis. Among those with ICU utilization, average ICU days were greater for patients with sepsis compared to those without (5.7 vs. 3.0 days). (all p< 0.05)
Conclusions: Sepsis during delivery is rare but clinically severe, with substantial disparities by age, race, insurance status, and social vulnerability. Despite national attention, delivery-associated sepsis has only increased. These inequitable and persistent trends underscore the need for routine infection surveillance during delivery and postpartum, along with sustained, equity-focused sepsis prevention strategies.
