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Objective  To identify factors associated with progression from pregnancy‐associated severe sepsis to death in the  UK .    Design  A population‐based case‐control analysis using data from the  UK  Obstetric Surveillance System ( UKOSS ) and the  UK  Confidential Enquiry into Maternal Death ( CEMD ).    Setting  All pregnancy care and death settings in  UK  hospitals.    Population  All non‐influenza sepsis‐related maternal deaths (January 2009 to December 2012) were included as cases ( n  = 43), and all women who survived severe non‐influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls ( n  = 358).    Methods  Cases and controls were identified using the  CEMD  and  UKOSS . Multivariable logistic regression was used to estimate adjusted odds ratios ( aOR ) with 95% confidence intervals.    Main outcome measures  Odds ratios for socio‐demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.    Results  Four factors were included in the final regression model. Women who died were more likely to have never received antibiotics [ aOR  = 22.7, 95% confidence interval ( CI ) 3.64–141.6], to have medical comorbidities ( aOR  = 2.53, 95% CI  1.23–5.23) and to be multiparous ( aOR  = 3.57, 95% CI  1.62–7.89). Anaemia ( aOR  = 13.5, 95% CI  3.17–57.6) and immunosuppression ( aOR  = 15.0, 95% CI  1.93–116.9) were the two most important factors driving the association between medical comorbidities and progression to death.    Conclusions  There must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis‐related maternal deaths.    Tweetable abstract  Medical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis