Can a Simple Treatment Bundle Cut Maternal Sepsis Deaths?

Maternal infection is a significant cause of maternal illness and death worldwide. It is
associated with as many as half of in-hospital maternal deaths, with the greatest burden
observed in low- and middle-income countries where early detection and treatment remain challenging. Outcomes are especially poor in cases involving maternal sepsis. A landmark trial, the APT-Sepsis trial, published in the New England Journal of Medicine shows that a practical, low-cost intervention can dramatically reduce these preventable deaths.

What is FAST-M?

FAST-M is a maternal sepsis care bundle designed specifically for resource-limited settings. The acronym guides healthcare providers through five critical steps:

• Fluids
• Antibiotics
• Source control
• Transfer (if needed)
• Monitoring of mother and baby

The APT-Sepsis Trial Results

The Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) trial scaled up this
approach across 59 hospitals in Malawi and Uganda, with 30 assigned to the intervention group (15 in Malawi and 15 in Uganda) and 29 to the usual-care group (15 and 14, respectively), involving 431,394 women. The intervention combined three goals:

1. to improve hand-hygiene adherence,
2. to improve the prevention and management of maternal infection, and
3. to increase early recognition and bundled treatment of sepsis (FAST-M)

Key findings:

• Implementation of the APT-Sepsis program led to a significantly lower risk of a
  composite outcome of infection-related maternal death, infection-related near-miss event, or severe infection-related illness than usual care.
• For each of the goals the intervention of the APT-Sepsis program:

o Increased hand hygiene compliance by 14%
o Improved prevention in management of maternal infection via appropriate
antibiotic prophylaxis use by 15%
o Increased early recognition (32%) and bundled treatment of sepsis (8%)

• Effectiveness increased over time, with increased success by the final month of the trial.
• Results were consistent across both countries.
• No costly new resources required.

Why It Works in Low-Resource Settings

Unlike many maternal health interventions, APT-Sepsis was designed from the ground up for feasibility in resource-constrained environments. The program:

• Embeds within existing health systems
• Uses readily available medications and supplies
• Provides clear decision-making tools for frontline staff
  
• Requires minimal additional training

The intervention leverages modified early warning scores to track vital signs and trigger the FAST-M protocol when sepsis is suspected—a systematic approach that replaces inconsistent practices with standardized care.

Looking Ahead

These results demonstrate that structured, system-level interventions can overcome
longstanding barriers in maternal sepsis care. The low-cost, sustainable model is
designed for rapid scale-up through national and international health programs.
Extending this intervention to other countries and settings may require partnering with
national ministries of health, as in this trial, to facilitate uptake of the intervention and
to adapt materials and processes to ensure they are culturally and contextually
appropriate.

Further work is needed to evaluate patient and provider experiences, behavior changes,
and the cost-effectiveness of the intervention.

Read the full study:

"A Multicomponent Intervention to Improve Maternal Infection Outcomes"
in the New England Journal of Medicine (2025)

 By Brittany de Soto Palmer