Objective To evaluate whether the implementation of the FAST-M complex intervention was feasible and improved the recognition and management of maternal sepsis in a low-resource setting. Design A before-and-after design. Setting Fifteen government healthcare facilities in Malawi. Population Women suspected of having maternal sepsis. Methods The FAST-M complex intervention consisted of the following components: the FAST-M maternal sepsis treatment bundle and the FAST-M implementation programme. Performance of selected process outcomes was compared between a 2-month baseline phase and 6-month intervention phase with compliance used as a proxy measure of feasibility. Main outcome result Compliance with vital sign recording and use of the FAST-M maternal sepsis bundle. Results Following implementation of the FAST-M intervention, women were more likely to have a complete set of vital signs taken on admission to the wards (0/163 [0%] versus 169/252 [67.1%], P < 0.001). Recognition of suspected maternal sepsis improved with more cases identified following the intervention (12/106 [11.3%] versus 107/166 [64.5%], P < 0.001). Sepsis management improved, with women more likely to receive all components of the FAST-M treatment bundle within 1 hour of recognition (0/12 [0%] versus 21/107 [19.6%], P = 0.091). In particular, women were more likely to receive antibiotics (3/12 [25.0%] versus 72/107 [67.3%], P = 0.004) within 1 hour of recognition of suspected sepsis. Conclusion Implementation of the FAST-M complex intervention was feasible and led to the improved recognition and management of suspected maternal sepsis in a low-resource setting such as Malawi.

Objective To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings.Design Modified Delphi process.Setting Participants from 34 countries.Conclusion A clinically relevant maternal sepsis care bundle for low resource settings has been developed by international consensus.Keywords care bundle, Delphi process, low resource setting, maternal sepsis.Tweetable abstract A maternal sepsis care bundle for low resource settings has been developed by international consensus.

(BJOG. 2020;127:416–423) Although maternal sepsis is the third most common cause of global maternal mortality, there are no internationally recognized sepsis care bundles directed toward pregnant women that can be implemented in a low-resource setting. While the Surviving Sepsis Campaign’s (SSC) care bundle has been associated with reduced mortality for the general population, only 1.5% of health care facilities in Africa are able to implement the SSC guidelines in their entirety. The need to develop and implement effective strategies to reduce the global burden of maternal and neonatal sepsis in low-resource settings has become increasingly important, as demonstrated by a recent global directive by the World Health Organization (WHO) and Jhpiego. This study aimed to accomplish this directive by developing a care bundle for the initial management of maternal sepsis in low-resource settings.

No abstract