Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study

Abstract

Objective To determine the incidence of maternal bacteraemia during pregnancy and for 6 weeks postpartum, describe the gestation/stage at which sepsis occurs, the causative microorganisms, antibiotic resistance and review maternal, fetal and neonatal outcome. Design Prospective review.Setting Two tertiary referral, maternity hospitals in Dublin, Ireland.Population During 2005-2012 inclusive, 150 043 pregnant women attended and 24.4% of infants born in Ireland were delivered at the hospitals.Methods Demographic, clinical, microbiological and outcome data was collected from women with sepsis and compared with controls.Main outcome measures Incidence, bacterial aetiology, gestation/ stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome.Results The sepsis rate was 1.81 per 1000 pregnant women. Escherichia coli was the predominant pathogen, followed by Group B Streptococcus. Sepsis was more frequent among nulliparous women (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07-1.79) and multiple births (OR 2.04; 95% CI 0.98-4.08). Seventeen percent of sepsis episodes occurred antenatally, 36% intrapartum and 47% postpartum. The source of infection was the genital tract in 61% (95% CI 55.1-66.6) of patients and the urinary tract in 25% (95% CI 20.2-30.5). Sepsis was associated with preterm delivery (OR 2.81; 95% CI 1.99-3.96) and a high perinatal mortality rate (OR =5.78; 95% CI 2.89-11.21). Almost 14% of women required admission to augmented care. The most virulent organisms were Group A Streptococcus linked to postpartum sepsis at term and preterm Escherichia coli sepsis.Conclusions Maternal sepsis is associated with preterm birth, a high perinatal mortality rate and nulliparous women.

The response of the innate immune and cardiovascular systems to LPS in pregnant and nonpregnant mice†

“…All experiments in pregnant animals were conducted on day 16 of pregnancy (E16). This period was chosen as most cases of severe sepsis occur during the third trimester of human pregnancy [25].…”

“…Time to labor and pup survival were assessed in a vehicle (PBS) group and demonstrated no difference to untreated control data in our group (mean time to delivery in PBS-treated group 57.2 ± 6.6 compared with untreated group 55.6 ± 0.8). LPS administration demonstrated a dose-dependent reduction in time to delivery (Supplementary Table S3), but at high doses of 20 μg and above LPS caused maternal deaths (20,25,50, or 100 μg LPS; at least one maternal death per group, numbers shown in Supplementary Table S3). The dose of 10 μg caused no maternal deaths, was most reproducible preterm delivery, and had least variation in labor time, pup survival, and caused no maternal mortality (mean time to delivery 23 ± 2.07, Supplementary Table S3).…”

Interactions Among Urogenital, Intestinal, Skin, and Oral Infections in Pregnant and Lactating Panamanian Ngäbe Women: A Neglected Public Health Challenge

“…and Candida spp., 14,15 UTI associated with institutional vaginal delivery, 16 and puerperal sepsis mostly associated with vaginal infections. 17 In conditions of poverty where access to health care is limited, coinfection is likely common. Yet research on coinfections during pregnancy and lactation has primarily focused on the associations of HIV and malaria with other pathogens including intestinal nematodes [18][19][20] or associations with other infections of the intestine 21 or the reproductive tract.…”

Procalcitonin; a feasible biomarker for severe bacterial infections in Obstetrics and Gynecology?

“…In a recently reported study 17% of sepsis were diagnosed antepartum, 36% intrapartum and 47% were diagnosed in the postpartum period . The source of infection was most often the genital tract (61%), followed by the urinary tract in 25% of cases . Maternal sepsis was also a risk for the fetus, as it was associated with an increased risk of preterm delivery (OR 2.8), and a high perinatal mortality rate (OR 5.8) .…”