Peripartum sepsis is one of the leading reasons why pregnant women die worldwide, especially in developing and underdeveloped countries. It is a life-threatening condition that can lead to severe complications including death if not addressed early. Sepsis can occur during pregnancy, delivery, after delivery, and in the time surrounding an abortion. 
Pregnancy is an immunocompromised state already due to the physical changes that occur. So, some infections might be masked and detected later on when complications have set in. Sepsis results in multi-organ dysfunction, including significant compromise to the maternal circulation which affects the fetoplacental unit.
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According to WHO, almost half of maternal deaths that occur in the hospital are caused by sepsis and they also record an increasing number of incidences, especially in developing and underdeveloped countries. In the US, over 22% of maternal deaths are related to sepsis. Reports also estimate a 10% mortality rate in the UK.
Outcomes of peripartum sepsis include resolution on one hand and severe morbidity and fetomaternal death on the other hand. Treatment for maternal sepsis includes antibiotics, however, early recognition is key. Treatment includes fluid replacement, steroids, and the appropriate antibiotics.
Azithromycin for peripartum sepsis
Efforts have been made and are still currently being made to reduce the occurrence of peripartum sepsis and deaths from the same cause. One of them is to give prophylactic antibiotics before delivery to women at risk and even the ones not at risk. The idea is to reduce the occurrence of sepsis in pregnant women.
Research says that a single dose of azithromycin can reduce the incidence of peripartum sepsis significantly in pregnant women who are to undergo vaginal delivery. A randomized trial was done across different countries to find out if this method works. A single dose of 2g azithromycin was given to women who had reached at least 28 weeks of gestation. Results showed that the incidence of peripartum sepsis and deaths reduced significantly. A similar US study also recorded a close to 50% reduction in endometritis and wound infections.
The cost-effectiveness of azithromycin
Jackie Patterson et al. decided to evaluate the cost of adapting this regimen and its relationship to the overall healthcare cost of pregnant women in low to middle-income countries and this evaluation involved women who were to undergo planned vaginal deliveries. Evaluations revealed the cost of healthcare for one pregnancy was $0.91 and the median money saved was $18,451. Also, the application of azithromycin resulted in an aversion of 769 sepsis cases, 809 infection cases, and 495 hospitalizations per 100,000 pregnancies.
Why is this important
These values projected above show that the azithromycin method helps save healthcare funds in developing and underdeveloped countries. This is a very beneficial method for the regions because everyone can now afford to get pregnant without fear of complications or death from sepsis. Also, the fact that the regimen only involves a single dose shows how simple and easy to administer it is and if azithromycin is implemented in the long run, we might be trending towards zero peripartum sepsis and maternal death worldwide.
References
Patterson, J., Neuwahl, S., Moore, J., Carlo, W., Buserman, M., & Tita, A. T. (2024). Cost-effectiveness of Azithromycin for the prevention of maternal sepsis or death in planned vaginal births. American Journal of Obstetrics and Gynecology, 230(1, Supplement), S3-S4. https://doi.org/10.1016/j.ajog.2023.11.018
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