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Clinics in Perinatology Jun 2010Chorioamnionitis is a common complication of pregnancy associated with significant maternal, perinatal, and long-term adverse outcomes. Adverse maternal outcomes include... (Review)
Review
Chorioamnionitis is a common complication of pregnancy associated with significant maternal, perinatal, and long-term adverse outcomes. Adverse maternal outcomes include postpartum infections and sepsis whereas adverse infant outcomes include stillbirth, premature birth, neonatal sepsis, chronic lung disease, and brain injury leading to cerebral palsy and other neurodevelopmental disabilities. Research in the past 2 decades has expanded understanding of the mechanistic links between intra-amniotic infection and preterm delivery as well as morbidities of preterm and term infants. Recent and ongoing clinical research into better methods for diagnosing, treating, and preventing chorioamnionitis is likely to have a substantial impact on short and long-term outcomes in the neonate.
Topics: Chorioamnionitis; Diagnosis, Differential; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Risk Factors
PubMed: 20569811
DOI: 10.1016/j.clp.2010.02.003 -
Journal of Perinatology : Official... Jun 2023To examine the relationship between maternal sepsis, type of infection, and short-term neonatal outcomes.
OBJECTIVE
To examine the relationship between maternal sepsis, type of infection, and short-term neonatal outcomes.
STUDY DESIGN
We conducted a retrospective cohort study investigating pregnancies between 2005 and 2008 in California with antepartum maternal sepsis diagnosis. Comparisons were made between sepsis cases and controls, using chi-squared or Fisher's exact test. Multivariable logistic regression was performed, adjusting for maternal characteristics.
RESULTS
Several maternal characteristics were associated with increased odds of maternal sepsis. Both obstetric and non-obstetric infections were associated with maternal sepsis (p < 0.001). The positive predictive value of maternal sepsis for preterm delivery was 55.03%. Neonates born to maternal sepsis patients had a higher risk of developing neonatal complications including neonatal shock.
CONCLUSION
Maternal sepsis was associated with neonatal complications. Efforts to reduce maternal sepsis may improve neonatal outcomes. Further studies are required for a better understanding of these associations and whether prevention or more rapid diagnosis and treatment can lower these risks.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Retrospective Studies; Cohort Studies; Premature Birth; Sepsis; Pregnancy Complications, Infectious
PubMed: 37217673
DOI: 10.1038/s41372-023-01696-3 -
The Australian & New Zealand Journal of... Oct 2017SOMANZ (Society of Obstetric Medicine Australia and New Zealand) has written a guideline to provide evidence-based guidance for the investigation and care of women with...
SOMANZ (Society of Obstetric Medicine Australia and New Zealand) has written a guideline to provide evidence-based guidance for the investigation and care of women with sepsis in pregnancy or the postpartum period. The guideline is evidence-based and incorporates recent changes in the definition of sepsis. The etiology, investigation and treatment of bacterial, viral and non-infective causes of sepsis are discussed. Obstetric considerations relevant to anaesthetic and intensive care treatment in sepsis are also addressed. A multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women have contributed to the development of the guidelines. This is an executive summary of the guidelines.
Topics: Anesthesia, Obstetrical; Critical Care; Delivery, Obstetric; Female; Fever; Humans; Organ Dysfunction Scores; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Shock, Septic; Time Factors
PubMed: 28670748
DOI: 10.1111/ajo.12646 -
JAMA Mar 2023
Topics: Female; Humans; Pregnancy; Anti-Bacterial Agents; Antibiotic Prophylaxis; Pregnancy Complications, Infectious; Sepsis; Treatment Outcome
PubMed: 36811908
DOI: 10.1001/jama.2023.2094 -
The Lancet. Infectious Diseases Jul 2009Maternal and child health are high priorities for international development. Through a Review of published work, we show substantial gaps in current knowledge on... (Review)
Review
Maternal and child health are high priorities for international development. Through a Review of published work, we show substantial gaps in current knowledge on incidence (cases per live births), aetiology, and risk factors for both maternal and early onset neonatal bacterial sepsis in sub-Saharan Africa. Although existing published data suggest that sepsis causes about 10% of all maternal deaths and 26% of neonatal deaths, these are likely to be considerable underestimates because of methodological limitations. Successful intervention strategies in resource-rich settings and early studies in sub-Saharan Africa suggest that the burden of maternal and early onset neonatal bacterial sepsis could be reduced through simple interventions, including antiseptic and antibiotic treatment. An effective way to expedite evidence to guide interventions and determine the incidence, aetiology, and risk factors for sepsis in sub-Saharan Africa would be through a multiarmed factorial intervention trial aimed at reducing both maternal and early onset neonatal bacterial sepsis in sub-Saharan Africa.
Topics: Adolescent; Adult; Africa South of the Sahara; Female; Humans; Incidence; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Sepsis; Young Adult
PubMed: 19555902
DOI: 10.1016/S1473-3099(09)70172-0 -
British Journal of Anaesthesia Apr 2018
Topics: Female; Humans; Internationality; Pregnancy; Pregnancy Complications, Infectious; Sepsis
PubMed: 29576104
DOI: 10.1016/j.bja.2017.12.032 -
BMJ Case Reports Oct 2022Improving maternal and child health is a global priority. Although infection with (LM), a small facultative anaerobic, gram-positive motile bacillus is rare, when it...
Improving maternal and child health is a global priority. Although infection with (LM), a small facultative anaerobic, gram-positive motile bacillus is rare, when it infects the maternal-fetoplacental unit, it can result in adverse fetal sequelae such as chorioamnionitis, preterm labour, neonatal sepsis, meningitis and neonatal death. Pregnancy-associated listeriosis may present with a plethora of diverse, non-specific symptoms such as fever, influenza-like or gastrointestinal symptoms, premature contractions and preterm labour. It has a predilection for the second and third trimester of pregnancy, occurring sporadically or as part of an outbreak, most of which have involved unpasteurised dairy products, long shelf life products, contaminated ready-to-eat food, deli meats and soft cheeses. Strains belonging to the clonal complexes 1, 4 and 6 are hypervigilant and are commonly associated with maternal-neonatal infections. Maternal listeriosis occurs as a direct consequence of LM-specific placental tropism, which is mediated by the conjugated action of internalin A and internalin B at the placental barrier. The diagnosis is established from placental culture. Penicillin, ampicillin and amoxicillin are the antimicrobials of choice. It has a high fetal morbidity of up to 30%. The authors present the case of a multiparous woman in her early 20s presenting with sepsis and preterm premature rupture of her membranes at 21 weeks gestation. A live baby was delivered spontaneously and died shortly after birth. Placental cultures and postmortem examination were consistent with the diagnosis of disseminated infection. Due to the increased susceptibility of pregnant women for LM, a high index of clinical suspicion is required to establish the diagnosis and initiate appropriate antimicrobial therapy to reduce adverse fetal outcomes.
Topics: Amoxicillin; Child; Female; Humans; Infant, Newborn; Listeria monocytogenes; Listeriosis; Obstetric Labor, Premature; Penicillins; Placenta; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Sepsis
PubMed: 36192031
DOI: 10.1136/bcr-2022-249989 -
Journal of Neonatal-perinatal Medicine 2018A newborn male infant was admitted to the neonatal unit with suspected early onset neonatal sepsis for monitoring and intravenous antibiotics. Despite his initial normal... (Review)
Review
A newborn male infant was admitted to the neonatal unit with suspected early onset neonatal sepsis for monitoring and intravenous antibiotics. Despite his initial normal clinical and laboratory parameters, cerebrospinal fluid cultures done on day 4 of life confirmed Streptococcus oralis meningitis. His mother became unwell shortly after labour, and grew Streptococcus oralis in her blood cultures. Both were successfully treated with antibiotics and made a full recovery. Streptococcus oralis has been associated with meningitis in patients receiving spinal anaesthesia or following dental work, but is an uncommon cause of neonatal meningitis and maternal sepsis. We describe the first case in the literature where a mother-baby pair developed invasive non-pyogenic streptococcal disease with the same organism. There is a need for robust guidelines on antibiotic therapy in these cases.
Topics: Adult; Anti-Bacterial Agents; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Meningitis; Pregnancy; Pregnancy Complications, Infectious; Streptococcal Infections; Streptococcus oralis; Treatment Outcome
PubMed: 30040747
DOI: 10.3233/NPM-17113 -
Reproductive Health Jan 2018Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The...
BACKGROUND
Maternal sepsis is the underlying cause of 11% of all maternal deaths and a significant contributor to many deaths attributed to other underlying conditions. The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality. The objectives of the Global Maternal Sepsis Study (GLOSS) include: the development and validation of identification criteria for possible severe maternal infection and maternal sepsis; assessment of the frequency of use of a core set of practices recommended for prevention, early identification and management of maternal sepsis; further understanding of mother-to-child transmission of bacterial infection; assessment of the level of awareness about maternal and neonatal sepsis among health care providers; and establishment of a network of health care facilities to implement quality improvement strategies for better identification and management of maternal and early neonatal sepsis.
METHODS
This is a facility-based, prospective, one-week inception cohort study. This study will be implemented in health care facilities located in pre-specified geographical areas of participating countries across the WHO regions of Africa, Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific. During a seven-day period, all women admitted to or already hospitalised in participating facilities with suspected or confirmed infection during any stage of pregnancy through the 42nd day after abortion or childbirth will be included in the study. Included women will be followed during their stay in the facilities until hospital discharge, death or transfer to another health facility. The maximum intra-hospital follow-up period will be 42 days.
DISCUSSION
GLOSS will provide a set of actionable criteria for identification of women with possible severe maternal infection and maternal sepsis. This study will provide data on the frequency of maternal sepsis and uptake of effective diagnostic and therapeutic interventions in obstetrics in different hospitals and countries. We will also be able to explore links between interventions and maternal and perinatal outcomes and identify priority areas for action.
Topics: Female; Health Knowledge, Attitudes, Practice; Humans; Maternal Health Services; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Sepsis
PubMed: 29382352
DOI: 10.1186/s12978-017-0437-8 -
PloS One 2024Maternal disorders are the third leading cause of sepsis globally, accounting for 5.7 million (12%) cases in 2017. There are increasing concerns about the emergence of...
INTRODUCTION
Maternal disorders are the third leading cause of sepsis globally, accounting for 5.7 million (12%) cases in 2017. There are increasing concerns about the emergence of antimicrobial resistance (AMR) in bacteria commonly causing maternal sepsis. Our aim is to describe the protocol for a clinical and microbiology laboratory study to understand risk factors for and the bacterial etiology of maternal sepsis in a tertiary Obstetrics and Gynaecology Hospital.
METHODS
This case-control study aims to recruit 100 cases and 200 controls at Tu Du Hospital in Ho Chi Minh City, Vietnam, which had approximately 55,000 births in 2022. Women aged ≥ 18 years and ≥ 28 weeks gestation having a singleton birth will be eligible for inclusion as cases or controls, unless they have an uncomplicated localised or chronic infection, or an infection with SARS-CoV-2. Cases will include pregnant or recently pregnant women with sepsis recognised between the onset of labour and/or time of delivery/cessation of pregnancy for up to 42 days post-partum. Sepsis will be defined as suspected or confirmed infection with an obstetrically modified Sequential Organ Failure Assessment score of ≥ 2, treatment with intravenous antimicrobials and requested cultures of any bodily fluid. Controls will be matched by age, location, parity, mode of delivery and gestational age. Primary and secondary outcomes are risk factors associated with the development of maternal sepsis, the frequency of adverse outcomes due to maternal sepsis, bacterial etiology and AMR profiles of cases and controls.
DISCUSSION
This study will improve understanding of the epidemiology and clinical implications of maternal sepsis management including the presence of AMR in women giving birth in Vietnam. It will help us to determine whether women in this setting are receiving optimal care and to identify opportunities for improvement.
Topics: Humans; Female; Pregnancy; Case-Control Studies; Risk Factors; Sepsis; Vietnam; Pregnancy Complications, Infectious; Adult; Anti-Bacterial Agents
PubMed: 38924013
DOI: 10.1371/journal.pone.0305411