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Recording available 2/16-5/2

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Poster Session 1

Category: Obstetric Quality and Safety

Poster Session 1

(274) Comparing the Performance of a Novel Maternal Sepsis Screening Score to Clinician Judgement

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Leah A. Chen, MD (she/her/hers)

Resident Physician
University of Pittsburgh Magee Women's Hospital
Pittsburgh, Pennsylvania, United States

Coauthor(s)

AH

Alexa Henderson, MD

MFM Fellow
UPMC Magee Women's Hospital
University of Pittsburgh Magee Women’s Hospital, Pennsylvania, United States
Anna B. Binstock, MD (she/her/hers)

Assistant Professor, Maternal-Fetal Medicine
UPMC Magee-Womens Hospital
UPMC, Pennsylvania, United States
Christina J. Megli, MD, PhD

Maternal Fetal Medicine Attending Physician
University of Pittsburgh Magee Women's Hospital
University of Pittsburgh Magee Women's Hospital, Pennsylvania, United States

Objective:
The physiologic changes of pregnancy pose challenges to establishing sepsis screening thresholds. To address this, our institution developed a sepsis alert system with a maternal sepsis score (MSS), with the goal of accelerating obstetric sepsis recognition and treatment. A sepsis work-up order set was also added and used at clinician discretion, including blood cultures, antibiotics, and fluid resuscitation. The MSS uses obstetric adjusted Systemic Inflammatory Response Syndrome (SIRS) criteria in combination with signs of organ dysfunction (Figure 1). We performed a retrospective analysis to compare the performance of MSS to “clinician judgement” (clinician-initiated sepsis workups) and previously established maternal sepsis scores.

Study Design:
Inclusion criteria consisted of patients who were pregnant or within 6 weeks postpartum and had an MSS alert or clinician-initiated sepsis work-up from February to August 2024. The clinical course, vital signs, and labs were abstracted. Sepsis was defined if patients had sustained vital sign or lab abnormalities and a pathogenic infection with an identified organism. We compared MSS with SIRS, Maternal Early Warning Trigger (MEWT), and Maternal Early Warning Criteria (MEWC).

Results:
Out of 208 cases, the true sepsis rate was 36%. Most false positive MSS alerts were in patients with normal labor or intra-operative Cesarean section (28%), or in those with an isolated postpartum hemorrhage (20%). MSS alone had a poor PPV for maternal sepsis (0.25). There were 7 cases where clinician judgement and MSS overlapped. These limited cases had a PPV of 0.57. Clinical judgement alone had a PPV of 0.52. When tested on our cohort, unmodified SIRS, MEWC, and MEWT also had low PPVs of 0.37, 0.32, and 0.39.

Conclusion:
Our study supports prior work highlighting the complexity of creating clinically useful obstetric sepsis screening protocols, especially when applied universally across pregnancy stages and postpartum. This data also reinforces the need for experienced providers, as clinician judgement had a PPV rivaling established obstetric sepsis screening scores.