Perinatal outcomes among births to women with infection during pregnancy

Baguiya, Adama; Bonet, Mercedes; Cecatti, José Guilherme; Brizuela, Vanessa; Curteanu, Ala; Minkauskienė, Meilė; Jayaratne, Kapila; Ribeiro‐do‐Valle, Carolina C.; Budianu, Mihaela-Alexandra; Souza, João Paulo; Kouanda, Séni

doi:10.1136/archdischild-2021-321865

Cited by 12 publications

(12 citation statements)

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“…Significantly increased risk of fetal and neonatal deaths have been reported in countries where systemic infections/ sepsis are among the leading causes of maternal morbidity and mortality [ 32 , 33 ]. Extremely low survival rates of the babies among the reviewed cases of maternal deaths (3/15) and maternal near-miss (8/19) support the association between SMO and poor perinatal outcomes [ 34 ]. Beyond coverage of essential interventions, delays in quality care implementation and lack of comprehensive supportive care are hypothesized contributors to maternal outcomes, and in turn, perinatal survival [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

Romero¹,

Keke²,

Sedami³

et al. 2022

BMC Pregnancy Childbirth

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Background Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. Method An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. Results Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. Conclusion Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.

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Section: Discussionmentioning

confidence: 99%

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

Romero¹,

Keke²,

Sedami³

et al. 2022

BMC Pregnancy Childbirth

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“…In Low and Middle Income Countries (LMIC), the recent study by Baguiya et al ( 69 ) show the devastating impact of maternal pre-existing conditions and suspected or confirmed infections on neonatal outcomes. This multinational team of investigators conducted a study in 2017 in 408 hospitals in 43 LMIC in all WHO regions.…”

Section: The Third Discrete and Blatant Event Of Parturition And Birthmentioning

confidence: 99%

Pre-birth acquisition of personhood: Incremental accrual of attributes as the framework for individualization by serial and concurrently acting developmental factors

Hughes

2023

Front. Reprod. Health

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Discrete events and processes influence development of individual humans. Attribution of personhood to any individual human being cannot be disconnected from the underlying biological events and processes of early human development. Nonetheless, the philosophical, sociological and legal components that are integral to the meaning of the term as commonly used cannot be deduced from biology alone. The challenge for biomedical scientists to inform discussion in this arena then rests on profiling the key biological events and processes that must be assessed when considering how one might objectively reason about the task of superimposing the concept of personhood onto the developing biological entity of a potential human being. Endogenous genetic and epigenetic events and exogenous developmental milieu processes diversify developmental trajectories of potential individual humans prior to livebirth. First, fertilization and epigenetic resetting of each individual's organismic clock to time zero (t = 0) at the gastrulation/primitive streak stage (day 15 of embryogenesis), are two discrete unseen biological events that impact a potential individual human's attributes. Second, those two discrete unseen biological events are immersed in the continuous developmental process spanning pre-fertilization and gestation, further driving individualization of diverse attributes of each future human before the third discrete and blatant biological event of parturition and livebirth. Exposures of the gravida to multiple diverse exogenous exposures means that morphogenesis and physiogenesis of every embryo/fetus has individualized attributes for its future human lifespan. Our proposed framework based on the biological discrete events and processes spanning pre-fertilization and prenatal development, implies that personhood should be incrementally attributed, and societal protections should be graduated and applied progressively across the pre-birth timespan.

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“…Maternal infection during pregnancy and the puerperium, accounting for 10% of maternal deaths, is a top cause of maternal mortality worldwide 1. Maternal infections increase neonatal sepsis, a leading cause of neonatal death in low-income countries (LICs) 2–5. Neonatal infection accounts for 15% of neonatal mortality worldwide 2.…”

Section: Introductionmentioning

confidence: 99%

Prevention of maternal and neonatal death/infections with a single oral dose of azithromycin in women in labour in low-income and middle-income countries (A-PLUS): a study protocol for a multinational, randomised placebo-controlled clinical trial

Hemingway-Foday,

Tita,

Chomba

et al. 2023

BMJ Open

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IntroductionMaternal and neonatal infections are among the most frequent causes of maternal and neonatal mortality, and current antibiotic strategies have been ineffective in preventing many of these deaths. A randomised clinical trial conducted in a single site in The Gambia showed that treatment with an oral dose of 2 g azithromycin versus placebo for all women in labour reduced certain maternal and neonatal infections. However, it is unknown if this therapy reduces maternal and neonatal sepsis and mortality. In a large, multinational randomised trial, we will evaluate the impact of azithromycin given in labour to improve maternal and newborn outcomes.Methods and analysisThis randomised, placebo-controlled, multicentre clinical trial includes two primary hypotheses, one maternal and one neonatal. The maternal hypothesis is to test whether a single, prophylactic intrapartum oral dose of 2 g azithromycin given to women in labour will reduce maternal death or sepsis. The neonatal hypothesis will test whether this intervention will reduce intrapartum/neonatal death or sepsis. The intervention is a single, prophylactic intrapartum oral dose of 2 g azithromycin, compared with a single intrapartum oral dose of an identical appearing placebo. A total of 34 000 labouring women from 8 research sites in sub-Saharan Africa, South Asia and Latin America will be randomised with a one-to-one ratio to intervention/placebo. In addition, we will assess antimicrobial resistance in a sample of women and their newborns.Ethics and disseminationThe study protocol has been reviewed and ethics approval obtained from all the relevant ethical review boards at each research site. The results will be disseminated via peer-reviewed journals and national and international scientific forums.Trial registration numberNCT03871491(https://clinicaltrials.gov/ct2/show/NCT03871491?term=NCT03871491&draw=2&rank=1).

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Perinatal outcomes among births to women with infection during pregnancy

Cited by 12 publications

References 30 publications

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries – case report series and suggested actions

Pre-birth acquisition of personhood: Incremental accrual of attributes as the framework for individualization by serial and concurrently acting developmental factors

Prevention of maternal and neonatal death/infections with a single oral dose of azithromycin in women in labour in low-income and middle-income countries (A-PLUS): a study protocol for a multinational, randomised placebo-controlled clinical trial

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