Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage

Abstract

Objective To examine the association between the use of invasive treatments for postpartum hemorrhage and the risk of sepsis and severe sepsis. Methods Secondary data analysis of the WOMAN randomized controlled trial, including 20 060 women with postpartum hemorrhage in 21 countries. Logistic regression with random effects was used. Results The cumulative incidence was 1.8% for sepsis and 0.5% for severe sepsis. All‐cause mortality was 40.4% in women with severe sepsis versus 2.2% for women without. After adjusting for bleeding severity and other confounders, intrauterine tamponade, hysterectomy, and laparotomy increased the risk of sepsis (aOR 1.77 [95% CI 1.21–2.59], P=0.004; aOR 1.97 [95% CI 1.49–2.65], P<0.001; and aOR 6.63 [95% CI 4.29–10.24], P<0.001, respectively) and severe sepsis (aOR 2.60 [95% CI 1.47–4.59], P=0.002; aOR 1.97 [95% CI 0.83–2.46], P=0.033; and aOR 5.35 [95% CI 2.61–10.98], P<0.001, respectively). Conclusion In this secondary data analysis, certain invasive treatments for postpartum hemorrhage appear to increase the risk of sepsis. Further research is needed to confirm this finding and investigate the role of prophylactic antibiotics during these procedures. The harms and benefits of such interventions must be carefully weighed, both in treatment guidelines and during individual patient management. Trial Registration: ISRCTN76912190

Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

“…Infections were the underlying cause of most intrahospital deaths attributed to other direct (eg, abortionrelated) and indirect (eg, respiratory infection, meningitis) causes. Infections were also present in about a third of deaths attributed to other causes, in concurrence with previous findings in obstetric, [20][21][22][23] and general populations. 10 These results suggest that the role of infections as an underlying or contributing cause of maternal deaths, across the continuum from pregnancy to post-partum or post-abortion, is higher than previously thought.…”

“…30 Reverse causality might also complicate this association in cases of multiple maternal complications-eg, infection and post-partum haemorrhage. 21 A detailed description of strategies put in place to address potential sources of selection and measurement bias in our study is presented in the published protocol. 18 We expected a minimal effect of geographical or seasonal clusters of infectious morbidities given the large number of countries distributed between the northern and southern hemispheres and that most of the cases would be genitourinary tract infections not subjected to seasonality.…”

Effect of Baogong Zhixue Granules Combined with Tranexamic Acid Injection on the Hemodynamics and Reproductive System in Patients with Postpartum Hemorrhage after Cesarean Section

“…Related studies have shown that maternal mortality caused by obstetric hemorrhage ranks first in maternal deaths, and obstetric blood consumption takes third place in the clinical use of blood, accounting for 6% of total blood transfusion volume [ 16 ]. Postpartum hemorrhage (PPH), a common complication of cesarean section, is mainly caused by maternal physical weakness, emotional tension, and injuries of the uterine muscle wall, adding to the risk of perioperative maternal deaths if no timely and effective treatment is taken for puerperae.…”

Prevalence and Risk Factors of Severe Postpartum Hemorrhage: a Retrospective Cohort Study

“…Mothers with SPPH had 6.53 times the risk of sepsis compared with controls. The association between SPPH and sepsis is partly explained by underlying factors or procedures such as prolonged labor, manual removal of placenta, injuries and surgical interventions to stop bleeding [31]. In addition, the consequent anemia increases the risk of postpartum infections and consequently sepsis.…”