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BMJ Open Aug 2016To describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK.
OBJECTIVES
To describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK.
DESIGN
National cohort study.
SETTING
198 critical care units in the UK.
PARTICIPANTS
646 pregnant and recently pregnant women who had severe sepsis within the first 24 hours of admission in 2008-2010.
PRIMARY AND SECONDARY OUTCOME MEASURES
Septic shock, mortality.
RESULTS
Of all maternal critical care admissions, 14.4% (n=646) had severe sepsis; 10.6% (n=474) had septic shock. The absolute risk of maternal critical care admission with severe sepsis was 4.1/10 000 maternities. Pneumonia/respiratory infection (irrespective of the H1N1 pandemic influenza strain) and genital tract infection were the most common sources of sepsis (40% and 24%, respectively). We identified a significant gradient in the risk of severe maternal sepsis associated with increasing deprivation (RR=6.5; 95% CI 4.9 to 8.5 most deprived compared with most affluent women). The absolute risk of mortality was 1.8/100 000 maternities. The most common source of infection among women who died was pneumonia/respiratory infection (41%). Known risk factors for morbidity supported by this study were: younger age, multiple gestation birth and caesarean section. Significant risk factors for mortality in unadjusted analysis were: age ≥35 years (unadjusted OR (uOR)=3.5; 95% CI 1.1 to 10.6), ≥3 organ system dysfunctions (uOR=12.7; 95% CI 2.9 to 55.1), respiratory dysfunction (uOR=6.5; 95% CI1.9 to 21.6), renal dysfunction (uOR=5.6; 95% CI 2.3 to 13.4) and haematological dysfunction (uOR=6.5; 95% CI 2.9 to 14.6).
CONCLUSIONS
This study suggests a need to improve timely recognition of severe respiratory tract and genital tract infection in the obstetric population. The social gradient associated with the risk of severe sepsis morbidity and mortality raises important questions regarding maternal health service provision and usage.
Topics: Adolescent; Adult; Age Factors; Causality; Cesarean Section; Cohort Studies; Female; Humans; Incidence; Maternal Mortality; Parity; Postnatal Care; Pregnancy; Pregnancy Complications, Infectious; Respiratory Tract Infections; Risk Factors; Sensitivity and Specificity; Sepsis; Severity of Illness Index; Young Adult
PubMed: 27554107
DOI: 10.1136/bmjopen-2016-012323 -
The Journal of Perinatal & Neonatal... 2009Perinatal sepsis is one of the most challenging problems encountered in obstetric and intensive care. Sepsis is a clinical diagnosis and a serious pathologic process... (Review)
Review
Perinatal sepsis is one of the most challenging problems encountered in obstetric and intensive care. Sepsis is a clinical diagnosis and a serious pathologic process involving widespread release of inflammatory mediators that may lead to organ injury or rapid deterioration. Normal physiologic maternal adaptations in the intrapartal and early postpartal period may mask the subtle signs of sepsis. Attention to risk factors and early detection may improve outcome of the woman with perinatal sepsis.
Topics: Adult; Comorbidity; Critical Care; Early Diagnosis; Female; Health Knowledge, Attitudes, Practice; Humans; Incidence; Infant, Newborn; Maternal Welfare; Neonatal Nursing; Perinatal Care; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Quality Assurance, Health Care; Risk Factors; Sepsis; Severity of Illness Index; United States
PubMed: 19209059
DOI: 10.1097/JPN.0b013e31819614ed -
Pediatrics Aug 2019Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants.... (Review)
Review
Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. Administration of intrapartum antibiotic prophylaxis is the only currently available effective strategy for the prevention of perinatal GBS early-onset disease, and there is no effective approach for the prevention of late-onset disease. The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis. The purpose of this clinical report is to provide neonatal clinicians with updated information regarding the epidemiology of GBS disease as well current recommendations for the evaluation of newborn infants at risk for GBS disease and for treatment of those with confirmed GBS infection. This clinical report is endorsed by the American College of Obstetricians and Gynecologists (ACOG), July 2019, and should be construed as ACOG clinical guidance.
Topics: Antibiotic Prophylaxis; Disease Management; Female; Humans; Infant, Newborn; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Streptococcal Infections
PubMed: 31285392
DOI: 10.1542/peds.2019-1881 -
Acta Obstetricia Et Gynecologica... 2009To assess incidence and risk factors of maternal mortality and severe morbidity from sepsis in the Netherlands.
OBJECTIVE
To assess incidence and risk factors of maternal mortality and severe morbidity from sepsis in the Netherlands.
DESIGN
A nationwide confidential enquiry into maternal mortality from 1993 to 2006 and severe maternal morbidity from 2004 to 2006.
SETTING
All 98 Dutch maternity units in the Netherlands.
POPULATION
All pregnant women in the Netherlands from 1993 to 2006.
METHODS
All reported cases of maternal death from sepsis during 1993-2006 were reported to the Maternal Mortality Committee. Cases of severe maternal morbidity from sepsis from 2004 to 2006 were collected in a nationwide design. Main outcome measures. Incidence, case fatality rates, and possible risk factors.
RESULTS
The maternal mortality ratio from direct maternal mortality from sepsis was 0.73 per 100,000 live births (20/2,742,265). The incidence of severe maternal morbidity from sepsis was 21 per 100,000 deliveries (78/371,021), of which 79% was admitted to the intensive care unit. High age, multiple pregnancies, and the use of artificial reproduction techniques were significant risk factors for developing sepsis in univariate analysis. The overall case fatality rate for sepsis during 2004-2006 was 7.7% (6/78). Group A streptococcal infection was in 42.9% (9/21), the cause of direct maternal mortality from sepsis (1993-2006). In 31.8% (14/44), Group A streptococcal infection was the cause of obstetric morbidity from sepsis (2004-2006).
CONCLUSIONS
With a case fatality rate of 7.7%, sepsis is a life threatening condition for women during pregnancy, childbirth, and puerperium.
Topics: Female; Humans; Incidence; Maternal Mortality; Morbidity; Netherlands; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; Sepsis; Streptococcal Infections; Streptococcus pyogenes
PubMed: 19412806
DOI: 10.1080/00016340902926734 -
The Lancet. Global Health Sep 2021Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners,...
BACKGROUND
Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes.
METHODS
GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes.
FINDINGS
We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05-3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02-5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities).
INTERPRETATION
While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes.
FUNDING
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development.
Topics: Cross-Sectional Studies; Female; Global Health; Health Facilities; Health Resources; Humans; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Treatment Outcome; World Health Organization
PubMed: 34273300
DOI: 10.1016/S2214-109X(21)00248-5 -
The Journal of Perinatal & Neonatal...
Topics: Female; Humans; Maternal Mortality; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Sepsis
PubMed: 33900243
DOI: 10.1097/JPN.0000000000000574 -
BMC Infectious Diseases Feb 2024Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite...
BACKGROUND
Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes.
METHODS
A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression.
RESULTS
Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO.
CONCLUSIONS
This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options.
Topics: Pregnancy; Female; Humans; Retrospective Studies; Shock, Septic; Tertiary Care Centers; Ethiopia; Cross-Sectional Studies; Sepsis; Maternal Death; Pre-Eclampsia; Maternal Mortality; Pregnancy Complications, Infectious
PubMed: 38326776
DOI: 10.1186/s12879-024-09075-9 -
Best Practice & Research. Clinical... Aug 2013Sepsis is a major cause of maternal mortality and morbidity worldwide. In the UK, sepsis is now the leading cause of direct maternal deaths. Raising awareness among... (Review)
Review
Sepsis is a major cause of maternal mortality and morbidity worldwide. In the UK, sepsis is now the leading cause of direct maternal deaths. Raising awareness among healthcare professionals about the risks of maternal sepsis and the importance of early management is urgently needed. The challenge in the management of maternal sepsis is the translation of the vast knowledge gained from sequential confidential enquiries into maternal death and research findings, into clinical practice, to ensure an improvement in patient quality of care and maternal mortality and morbidity. In this chapter, I give an overview of the management of the risks of sepsis, and discuss implementation strategies that may reduce these risks.
Topics: Female; Humans; Maternal Mortality; Patient Safety; Pregnancy; Pregnancy Complications, Infectious; Quality Improvement; Risk Factors; Risk Management; Sepsis
PubMed: 23639681
DOI: 10.1016/j.bpobgyn.2013.04.003 -
BJOG : An International Journal of... Feb 2020To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings.
OBJECTIVE
To develop a sepsis care bundle for the initial management of maternal sepsis in low resource settings.
DESIGN
Modified Delphi process.
SETTING
Participants from 34 countries.
POPULATION
Healthcare practitioners working in low resource settings (n = 143; 34 countries), members of an expert panel (n = 11) and consultation with the World Health Organization Global Maternal and Neonatal Sepsis Initiative technical working group.
METHODS
We reviewed the literature to identify all potential interventions and practices around the initial management of sepsis that could be bundled together. A modified Delphi process, using an online questionnaire and in-person meetings, was then undertaken to gain consensus on bundle items. Participants ranked potential bundle items in terms of perceived importance and feasibility, considering their use in both hospitals and health centres. Findings from the healthcare practitioners were then triangulated with those of the experts.
MAIN OUTCOME MEASURE
Consensus on bundle items.
RESULTS
Consensus was reached after three consultation rounds, with the same items deemed most important and feasible by both the healthcare practitioners and expert panel. Final bundle items selected were: (1) Fluids, (2) Antibiotics, (3) Source identification and control, (4) Transfer (to appropriate higher-level care) and (5) Monitoring (of both mother and neonate as appropriate). The bundle was given the acronym 'FAST-M'.
CONCLUSION
A clinically relevant maternal sepsis bundle for low resource settings has been developed by international consensus.
TWEETABLE ABSTRACT
A maternal sepsis bundle for low resource settings has been developed by international consensus.
Topics: Consensus; Delphi Technique; Female; Humans; Infant, Newborn; International Cooperation; Medically Underserved Area; Patient Care Bundles; Patient Care Management; Pregnancy; Pregnancy Complications, Infectious; World Health Organization
PubMed: 31677228
DOI: 10.1111/1471-0528.16005 -
BMJ Open Sep 2022A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called 'FAST-M'...
OBJECTIVE
A maternal sepsis management bundle for resource-limited settings was developed through a synthesis of evidence and international consensus. This bundle, called 'FAST-M' consists of: Fluids, Antibiotics, Source control, assessment of the need to Transport/Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). The study aimed to adapt the FAST-M intervention including the bundle care tools for early identification and management of maternal sepsis in a low-resource setting of Pakistan and identify potential facilitators and barriers to its implementation.
SETTING
The study was conducted at the Liaquat University of Medical and Health Sciences, which is a tertiary referral public sector hospital in Hyderabad.
DESIGN AND PARTICIPANTS
A qualitative exploratory study comprising key informant interviews and a focus group discussion was conducted with healthcare providers (HCPs) working in the study setting between November 2020 and January 2021, to ascertain the potential facilitators and barriers to the implementation of the FAST-M intervention. Interview guides were developed using the five domains of the Consolidated Framework for Implementation Research: intervention characteristics, outer setting, inner setting, characteristics of the individuals and process of implementation.
RESULTS
Four overarching themes were identified, the hindering factors for implementation of the FAST-M intervention were: (1) Challenges in existing system such as a shortage of resources and lack of quality assurance; and (2) Clinical practice variation that includes lack of sepsis guidelines and documentation; the facilitating factors identified were: (3) HCPs' perceptions about the FAST-M intervention and their positive views about its execution and (4) Development of HCPs readiness for FAST-M implementation that aided in identifying solutions to potential hindering factors at their clinical setting.
CONCLUSION
The study has identified potential gaps and probable solutions to the implementation of the FAST-M intervention, with modifications for adaptation in the local context TRIAL REGISTRATION NUMBER: ISRCTN17105658.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pakistan; Qualitative Research; Focus Groups; Health Personnel; Pregnancy Complications, Infectious
PubMed: 36691196
DOI: 10.1136/bmjopen-2021-059273