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Hospital Practice (1995) 2024Sepsis is a common cause of maternal mortality and morbidity. Early detection and rapid management are essential. In this study, we evaluate the compliance with the...
OBJECTIVES
Sepsis is a common cause of maternal mortality and morbidity. Early detection and rapid management are essential. In this study, we evaluate the compliance with the implemented maternity-specific Early Warning Score (EWS), Rapid Response Team (RRT) protocol and the Surviving Sepsis Campaign (SSC) Hour-1 Bundle in a tertiary hospital in the Netherlands.
METHODS
We performed a retrospective patient chart review from July 2019 to June 2020 at the Leiden University Medical Centre. We included women who received therapeutic antibiotics and were admitted for at least 24 hours.
RESULTS
We included 240 women: ten were admitted twice and one woman three times, comprising 252 admissions. A clinical diagnosis of sepsis was made in 22 women. The EWS was used in 29% ( = 73/252) of admissions. Recommendations on the follow-up of the EWS were carried out in 53% ( = 46/87). Compliance with the RRT protocol was highest for assessment by a medical doctor within 30 minutes ( = 98/117, 84%) and lowest for RRT involvement ( = 7/23, 30%). In women with sepsis, compliance with the SSC Bundle was highest for acquiring blood cultures ( = 19/22, 85%), while only 64% ( = 14/22) received antibiotics within 60 minutes of the sepsis diagnosis.
CONCLUSION
The adherence to the maternity-specific EWS and the SSC Hour-1 bundle was insufficient, even within this tertiary setting in a high-income country.
Topics: Humans; Female; Netherlands; Tertiary Care Centers; Retrospective Studies; Sepsis; Guideline Adherence; Adult; Pregnancy; Anti-Bacterial Agents; Early Warning Score; Practice Guidelines as Topic; Pregnancy Complications, Infectious
PubMed: 38407122
DOI: 10.1080/21548331.2024.2320068 -
Obstetrical & Gynecological Survey Apr 2023Sepsis is one of the leading causes of maternal morbidity and mortality worldwide and a major public health concern, often associated with delayed diagnosis, suboptimal... (Review)
Review
INTRODUCTION
Sepsis is one of the leading causes of maternal morbidity and mortality worldwide and a major public health concern, often associated with delayed diagnosis, suboptimal management, and poor perinatal outcomes.
OBJECTIVES
The aim of this study was to review and compare the most recently published influential guidelines on the prevention, diagnosis, and management of this complication during antenatal, intrapartum, and postpartum periods.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Society for Maternal-Fetal Medicine (SMFM), the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), the World Health Organization (WHO), and the Society of Obstetricians and Gynecologists of Canada (SOGC) on maternal and puerperal sepsis was carried out.
RESULTS
RCOG, SMFM, and SOMANZ provide guidance on the diagnosis and management of sepsis in pregnancy and the puerperium, whereas the WHO and the SOGC refer only to the prevention of peripartum infections. There is a consensus among the reviewed guidelines that a detailed personal history, along with physical examination, cultures, laboratory tests, and appropriate imaging, is the mainstay in sepsis diagnosis; however, there are several discrepancies regarding the diagnostic criteria. On management, the necessity of broad-spectrum antibiotics administration, within the first hour from recognition, and early source control are underlined by RCOG, SMFM, and SOMANZ. Furthermore, adequate fluid resuscitation with crystalloids is required, targeting for a mean arterial pressure (MAP) >65 mm Hg, whereas persistent hypotension or tissue hypoperfusion should be managed with vasopressors. In addition, RCOG, SMFM, and SOMANZ agree that increased fetal surveillance is warranted in case of maternal sepsis and point out that the decision regarding the optimal time of delivery should be guided according to maternal and fetal condition. In case of preterm labor, the use of corticosteroids should be considered. Moreover, SOMANZ and SMFM recommend thromboprophylaxis for septic women. With regards to prevention of peripartum infections, the WHO recommends prophylactic antibiotic administration in case of cesarean delivery, group B colonization, manual placenta removal, third/fourth-degree perineal tears, and preterm premature rupture of membranes, while discouraging antibiotics in case of preterm labor with intact membranes, prelabor rupture of membranes at term, meconium-stained amniotic fluid, uncomplicated vaginal birth, episiotomy, and operative vaginal delivery. Finally, SOGC, although supporting antibiotic prophylaxis for cesarean delivery and third/fourth-degree perineal injury, does not recommend this intervention in case of manual placenta removal, postpartum dilatation, and curettage for retained products of conception, operative vaginal delivery, and cervical cerclage.
CONCLUSIONS
Sepsis remains a significant contributor of maternal morbidity and mortality with a constantly rising global incidence, despite the advances in diagnostic and therapeutic techniques. Thus, the development of consistent international practice protocols for the prevention, timely recognition, and effective management of this complication both in pregnancy and in the puerperium seems of paramount importance to safely guide clinical practice and subsequently improve perinatal outcomes.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Anticoagulants; Venous Thromboembolism; Postpartum Period; Anti-Bacterial Agents; Pregnancy Complications, Infectious; Sepsis; Premature Birth
PubMed: 37043300
DOI: 10.1097/OGX.0000000000001108 -
Virulence Dec 2020
Topics: Female; Fetus; Humans; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Tropism
PubMed: 32363994
DOI: 10.1080/21505594.2020.1759288 -
BJOG : An International Journal of... Mar 2012To describe the risk of maternal sepsis associated with obesity and other understudied risk factors such as operative vaginal delivery.
OBJECTIVE
To describe the risk of maternal sepsis associated with obesity and other understudied risk factors such as operative vaginal delivery.
DESIGN
Population-based, case-control study.
SETTING
North NHS region of Scotland.
POPULATION
All cases of pregnant, intrapartum and postpartum women with International Classification of Disease-9 codes for sepsis or severe sepsis recorded in the Aberdeen Maternal and Neonatal Databank (AMND) from 1986 to 2009. Four controls per case selected from the AMND were frequency matched on year-of-delivery.
METHODS
Cases and controls were compared; significant variables from univariable regression were adjusted in a multivariable logistic regression model.
MAIN OUTCOME MEASURES
Dependent variables were uncomplicated sepsis or severe ('near-miss') sepsis. Independent variables were demographic, medical and clinical delivery characteristics. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) are reported.
RESULTS
Controlling for mode of delivery and demographic and clinical factors, obese women had twice the odds of uncomplicated sepsis (OR 2.12; 95% CI 1.14-3.89) compared with women of normal weight. Age <25 years (OR 5.15; 95% CI 2.43-10.90) and operative vaginal delivery (OR 2.20; 95% CI 1.02-4.87) were also significant predictors of sepsis. Known risk factors for maternal sepsis were also significant in this study (OR for uncomplicated and severe sepsis respectively): multiparity (OR 6.29, 12.04), anaemia (OR 3.43, 18.49), labour induction (OR 3.92 severe only), caesarean section (OR 3.23, 13.35), and preterm birth (OR 2.46 uncomplicated only).
CONCLUSIONS
Obesity, operative vaginal delivery and age <25 years are significant risk factors for sepsis and should be considered in clinical obstetric care.
Topics: Abortion, Septic; Adult; Age Distribution; Analysis of Variance; Asian People; Bacteremia; Black People; Body Mass Index; Case-Control Studies; Cesarean Section; Diabetes Mellitus, Type 1; Female; Hospitals, Maternity; Hospitals, University; Humans; Incidence; Infant, Newborn; Logistic Models; Maternal Mortality; Multivariate Analysis; Obesity; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Puerperal Infection; Risk Factors; Sampling Studies; Scotland; White People
PubMed: 22251396
DOI: 10.1111/j.1471-0528.2011.03239.x -
Journal of Epidemiology and Global... Jun 2020
Topics: Female; Humans; Maternal Health Services; Midwifery; Nurse's Role; Obstetrics and Gynecology Department, Hospital; Pregnancy; Pregnancy Complications, Infectious; Sepsis
PubMed: 32538024
DOI: 10.2991/jegh.k.200325.002 -
Obstetrics and Gynecology Oct 2015To identify maternal deaths due to sepsis in the state of Michigan, review the events leading to diagnosis, and evaluate treatment to identify areas for improvement.
OBJECTIVE
To identify maternal deaths due to sepsis in the state of Michigan, review the events leading to diagnosis, and evaluate treatment to identify areas for improvement.
METHODS
A case series was collected for maternal deaths due to sepsis from a cohort of maternal deaths in the state of Michigan. The study period was 1999-2006 and included deaths during pregnancy and up to 42 days postpartum. Cases were identified using Maternal Mortality Surveillance records from the Michigan Department of Community Health. Each case was reviewed by all authors.
RESULTS
Maternal sepsis was the cause of death in 15% (22/151) of pregnancy-related deaths. Of 22 deaths, 13 women presented to the hospital with sepsis, two developed sepsis during hospitalization, and seven developed sepsis at home without admission to the hospital for care. Review of available hospital records (n=15) revealed delays in initial appropriate antibiotic treatment occurred in 73% (11/15) of patients. Delay in escalation of care also occurred and was identified in 53% (8/15) of patients.
CONCLUSION
Common elements in these deaths illustrate three key delays that may have contributed to the deaths: in recognition of sepsis, in administration of appropriate antibiotics, and in escalation of care.
LEVEL OF EVIDENCE
III.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Female; Humans; Maternal Mortality; Michigan; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Young Adult
PubMed: 26348189
DOI: 10.1097/AOG.0000000000001028 -
International Journal of Gynaecology... Aug 2021Maternal sepsis is a life-threatening condition. Biomarkers have been found to be useful in early detection of sepsis in the critical care setting. We aimed to determine... (Observational Study)
Observational Study
OBJECTIVES
Maternal sepsis is a life-threatening condition. Biomarkers have been found to be useful in early detection of sepsis in the critical care setting. We aimed to determine the diagnostic performance of different biomarkers such as procalcitonin, C-reactive protein (CRP), absolute eosinophil count, and activated partial thromboplastin time (aPTT) in maternal sepsis.
METHODS
A total of 35 patients were enrolled in this prospective observational study. Patients with suspected sepsis were evaluated for multi-organ dysfunction. The blood samples for testing of these biomarker levels were obtained at the time of enrollment in the study (day 1), and on day 3 and day 7. Trends of each marker were followed and correlated with the clinical picture.
RESULTS
Of 35 enrolled patients, 30 completed the study. Among these, 18 had sepsis and 12 were designated as without sepsis. Sensitivities of procalcitonin, CRP, aPTT, and absolute eosinophil count were 83.33%, 77.78%, 55.56%, and 58.82% whereas their specificities were 66.67%, 75.0%, 100%, and 75%, respectively. Area under the curve was highest for procalcitonin (0.813) followed in decreasing order by CRP (0.778), aPTT (0.731), and eosinophil count (0.642), respectively.
CONCLUSION
Procalcitonin and CRP may be used as a valuable adjunct in the clinical stepwise approach for the prompt diagnosis of maternal sepsis.
Topics: Adult; Biomarkers; C-Reactive Protein; Early Diagnosis; Female; Humans; Leukocyte Count; Pregnancy; Pregnancy Complications, Infectious; Procalcitonin; Prospective Studies; Sepsis; Young Adult
PubMed: 33306836
DOI: 10.1002/ijgo.13525 -
BMJ Open Jul 2023Maternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (luids, ntibiotics, ource...
OBJECTIVE
Maternal sepsis is the third leading cause of maternal mortality globally. WHO and collaborators developed a care bundle called FAST-M (luids, ntibiotics, ource identification and treatment, ransfer and onitoring) for early identification and management of maternal sepsis in low-resource settings. This study aimed to determine feasibility of FAST-M intervention in a low-resource setting in Pakistan. The FAST-M intervention consists of maternal sepsis screening tools, treatment bundle and implementation programme.
DESIGN AND SETTING
A feasibility study with before and after design was conducted in women with suspected maternal sepsis admitted at the Liaquat University of Medical and Health Sciences hospital Hyderabad. The study outcomes were compared between baseline and intervention phases. In the baseline phase (2 months), the existing sepsis care practices were recorded, followed by a training programme for healthcare providers on the application of FAST-M tools. These tools were implemented in the intervention phase (4 months) to assess any change in clinical practices compared with the baseline phase.
RESULTS
During the FAST-M implementation, 439 women were included in the study. 242/439 were suspected maternal infection cases, and 138/242 were women with suspected maternal sepsis. The FAST-M bundle was implemented in women with suspected maternal sepsis. Following the FAST-M intervention, significant changes were observed. Improvements were seen in the monitoring of oxygen saturation measurements (25.5% vs 100%; difference: 74%; 95% CI: 68.4% to 80.5%; p<0.01), fetal heart rate assessment (58% vs 100%; difference: 42.0%; 95% CI: 33.7% to 50.3%; p≤0.01) and measurement of urine output (76.5% vs 100%; difference: 23.5%; 95% CI: 17.6% to 29.4%; p<0.01). Women with suspected maternal sepsis received all components of the treatment bundle within 1 hour of sepsis recognition (0% vs 70.5%; difference: 70.5%; 95% CI: 60.4% to 80.6%; p<0.01).
CONCLUSION
Implementation of the FAST-M intervention was considered feasible and enhanced early identification and management of maternal sepsis at the study site.
TRIAL REGISTRATION NUMBER
ISRCTN17105658.
Topics: Female; Humans; Pregnancy; Anti-Bacterial Agents; Feasibility Studies; Pakistan; Pregnancy Complications, Infectious; Sepsis
PubMed: 37518083
DOI: 10.1136/bmjopen-2022-069135 -
JAMA Sep 2019This study uses National Readmissions Database data to characterize incidence of and mortality due to maternal sepsis within 42 days of delivery hospitalization...
This study uses National Readmissions Database data to characterize incidence of and mortality due to maternal sepsis within 42 days of delivery hospitalization discharge in the United States between 2013 and 2016.
Topics: Adult; Female; Hospitalization; Humans; Incidence; Maternal Mortality; Pregnancy; Pregnancy Complications, Infectious; United States
PubMed: 31479129
DOI: 10.1001/jama.2019.9818 -
BMC Public Health Jun 2019An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to...
BACKGROUND
An awareness campaign set to accompany the Global Maternal Sepsis Study (GLOSS) was launched in 2017. In order to better develop and evaluate the campaign, we sought to understand the factors that influence awareness of maternal sepsis by exploring healthcare providers' knowledge, perception of enabling environments, and perception of severity of maternal sepsis.
METHODS
We used a mixed-methods approach that included 13 semi-structured interviews to GLOSS regional and country coordinators and 1555 surveys of providers working in GLOSS participating facilities. Directed content analysis and grounded theory were used for qualitative analysis, based on a framework including four overarching themes around maternal health conditions, determinants of maternal health, barriers and facilitators to sepsis identification and management, plus 24 additional sub-topics that emerged during the interviews. Descriptive statistics for frequencies and percentages were used for the quantitative analysis; significance was tested using Pearson χ. Logistic regressions were performed to adjust for selected variables.
RESULTS
Analysis of interviews described limited availability of resources, poor quality of care, insufficient training and lack of protocols as some of the barriers to maternal sepsis identification and management. Analysis from the quantitative survey showed that while 92% of respondents had heard of maternal sepsis only 15% were able to correctly define it and 43% to correctly identify initial management. Provider confidence, perceived availability of resources and of a supportive environment were low (33%, 38%, and 48% respectively). Overall, the predictor that most explained awareness was training. Respondents from the survey and interviewees identified sepsis among the main conditions affecting women at their facilities.
CONCLUSIONS
Awareness on maternal sepsis, while acknowledged as important, remains low. Healthcare providers need resources and support to feel confident about the correct identification and management of sepsis, as a prerequisite for the improvement of awareness of maternal sepsis. Similarly, providers need to know about maternal sepsis and its severity to understand the importance of reducing sepsis-related mortality and morbidity. Awareness raising campaigns can help bring neglected maternal health conditions, such as sepsis, to the forefront of global and local agendas.
Topics: Adult; Attitude of Health Personnel; Awareness; Clinical Competence; Female; Grounded Theory; Health Knowledge, Attitudes, Practice; Health Personnel; Health Resources; Humans; Logistic Models; Male; Perception; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Quality of Health Care; Severity of Illness Index; Surveys and Questionnaires; Young Adult
PubMed: 31159751
DOI: 10.1186/s12889-019-6920-0