Puerperal sepsis (genital tract sepsis) was the leading cause of maternal mortality in the UK during the 18th, 19th and early part of the 20th centuries. It occurred in epidemics and it was not until the discovery in 1935 of a dramatically effective treatment, Prontosil© (IG Farben), followed by sulphonamides from 1937 and penicillin from 1945, that mortality from puerperal sepsis began to fall in the UK.
By the early 1950s, when the present series of Confidential Enquiries into Maternal Deaths began, sepsis was well down the list of causes. In the triennium 1982–84, there were no deaths directly attributable to puerperal sepsis. However, deaths from sepsis have risen in subsequent years. There were 22 deaths in the triennium 2003–2005 from genital tract sepsis, 18 deaths directly related to sepsis in pregnancy, with one death from sepsis following an illegal abortion and two further late deaths (occurring 6 weeks after delivery).
In the triennium 2006–2008 sepsis rose to be the leading cause of direct maternal deaths in the UK. This increase is attributed to the rise in community-acquired Group A streptococcal disease. There were 29 deaths from genital tract sepsis in the triennium 2006–2008, 26 direct deaths and three late deaths. However, the latest MBRRACE-UK report (2018) showed that there has been a significant decrease in the mortality rate from genital tract sepsis in the UK from 1.13 maternal deaths per 100 000 maternities in 2006–08, to 0.29 per 100 000 maternities in 2012–14.
Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014-16. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2018.
Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJ (Eds) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care. Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2015. p 73–79.