Title : Physiological compensation in pregnancy: A case of severe sepsis undetected by MEWS

Pregnancy is associated with profound physiological adaptions that may maintain haemodynamic stability despite evolving critical illness. Although maternal sepsis remains a leading cause of morbidity and mortality (15% of direct maternal deaths in the UK), recognition may be delayed when physiological observations remain within expected pregnancy ranges. Early warning scores support clinical assessments but may not identify all deteriorating patients.

Observational studies have reported lower sepsis mortality in pregnant people compared with age-matched non-pregnant adults, raising questions about physiological reserve and its impact on recognition of illness (Martin et al, 2006).

*case study about pre-term rupture of membranes leading to septic shock. MEOWS=0 until delivery, and then in septic shock on ITU*

Physiological compensation is a double-edged sword: it may contribute to improved tolerance of early sepsis, but it can also delay recognition because patients appear well until they deteriorate rapidly. This case illustrates how physiological adaption in pregnancy may delay recognition of severe sepsis when deterioration is assessed primarily using physiological trigger scores.

Amy is a practising midwife with a special interest in maternal sepsis, maternal deterioration and acute maternity care. She works with the UK Sepsis Trust to improve awareness, education and early recognition of maternal sepsis among healthcare professionals, women and families.

Alongside her clinical role, Amy is passionate about raising awareness of maternal sepsis through education and advocacy. She shares evidence-based information and resources via her Instagram platform, **@maternalsepsisuk**, helping to increase understanding of the signs, symptoms and importance of early treatment.

Amy is committed to improving outcomes for women through education, early recognition and timely escalation of care.