Sepsis in obstetrics and the role of the anaesthetist

Lucas, D.N.; Robinson, P.N.; Nel, Mark

doi:10.1016/j.ijoa.2011.11.001

Cited by 41 publications

(19 citation statements)

References 85 publications

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“…7 For each death due to puerperal sepsis, ∼20 severe episodes occur, with several bacterial pathogens being responsible for these episodes. 8,9 Mastitis, although generally less severe than puerperal sepsis, affects up to 20% of lactating women, 10,11 with S aureus playing a leading role.…”

Section: What This Study Addsmentioning

confidence: 99%

Azithromycin in Labor Lowers Clinical Infections in Mothers and Newborns: A Double-Blind Trial

et al. 2017

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Section: What This Study Addsmentioning

confidence: 99%

Azithromycin in Labor Lowers Clinical Infections in Mothers and Newborns: A Double-Blind Trial

et al. 2017

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“…GAS is typically community acquired, and 5%–30% of the population are asymptomatic carriers. Recently, there has been a significant rise worldwide in group A streptococcal infections in the general population 26 27. All of the mothers who died from GAS-positive sepsis either worked with or had young children.…”

Section: Epidemiology Of Infections Associated With Pregnancymentioning

confidence: 99%

Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide

Buddeberg

Aveling

2015

Postgraduate Medical Journal

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Puerperal sepsis is one of the five leading causes of maternal mortality worldwide, and accounts for 15% of all maternal deaths. The WHO defined puerperal sepsis in 1992 as an infection of the genital tract occurring at any time between the rupture of membranes or labour and the 42nd day post partum; in which, two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge and delay in the reduction of the size of the uterus. At the same time, the WHO introduced the term puerperal infections, which also include non-genital infections in the obstetric population. Recent epidemiological data shows that puerperal sepsis and non-genital tract infections are a major area of concern. In puerperal sepsis, group A streptococcus (GAS) is the most feared pathogen. Up to 30% of the population are asymptomatic carriers of GAS. GAS commonly causes throat infections. Women who died from GAS-positive sepsis all had signs of a throat infection themselves or one of their family members suffered from a throat infection. The pathway of infection is from the hands of the pregnant women or the mother to her perineum. In non-genital tract infections, influenza viruses and the HIV pandemic in the developing part of the world are responsible for many maternal deaths, and demand our attention. The physiological changes of pregnancy and the puerperium can obscure the signs and symptoms of sepsis in the obstetric population. A high level of suspicion is, therefore, needed in the care for the sick pregnant patient. If sepsis is suspected, timely administration of antibiotics, sepsis care bundles, multidisciplinary discussion and early involvement of senior staff members are important to improve outcome.

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“…Pregnant and peripartum women represent a particularly vulnerable population for developing sepsis because the maternal immune system is modulated during these periods [11]. The systemic inflammatory response syndrome (SIRS), an indicator of uncomplicated sepsis, is usually recognized by specific biomarkers [12].…”

Section: Introductionmentioning

confidence: 99%

The Continuum of Maternal Sepsis Severity: Incidence and Risk Factors in a Population-Based Cohort Study

et al. 2013

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ObjectiveTo investigate the incidence and risk factors associated with uncomplicated maternal sepsis and progression to severe sepsis in a large population-based birth cohort.MethodsThis retrospective cohort study used linked hospital discharge and vital statistics records data for 1,622,474 live births in California during 2005–2007. Demographic and clinical factors were adjusted using multivariable logistic regression with robust standard errors.Results1598 mothers developed sepsis; incidence of all sepsis was 10 per 10,000 live births (95% CI = 9.4–10.3). Women had significantly increased adjusted odds (aOR) of developing sepsis if they were older (25–34 years: aOR = 1.29; ≥35 years: aOR = 1.41), had ≤high-school education (aOR = 1.63), public/no-insurance (aOR = 1.22) or a cesarean section (primary: aOR = 1.99; repeat: aOR = 1.25). 791 women progressed to severe sepsis; incidence of severe sepsis was 4.9 per 10,000 live births (95% CI = 4.5–5.2). Women had significantly increased adjusted odds of progressing to severe sepsis if they were Black (aOR = 2.09), Asian (aOR = 1.59), Hispanic (aOR = 1.42), had public/no-insurance (aOR = 1.52), delivered in hospitals with <1,000 births/year (aOR = 1.93), were primiparous (aOR = 2.03), had a multiple birth (aOR = 3.5), diabetes (aOR = 1.47), or chronic hypertension (aOR = 8.51). Preeclampsia and postpartum hemorrhage were also significantly associated with progression to severe sepsis (aOR = 3.72; aOR = 4.18). For every cumulative factor, risk of uncomplicated sepsis increased by 25% (95% CI = 17.4–32.3) and risk of progression to severe sepsis/septic shock increased by 57% (95% CI = 40.8–74.4).ConclusionsThe rate of severe sepsis was approximately twice the 1991–2003 national estimate. Risk factors identified are relevant to obstetric practice given their cumulative risk effect and the apparent increase in severe sepsis incidence.

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Sepsis in obstetrics and the role of the anaesthetist

Cited by 41 publications

References 85 publications

Azithromycin in Labor Lowers Clinical Infections in Mothers and Newborns: A Double-Blind Trial

Azithromycin in Labor Lowers Clinical Infections in Mothers and Newborns: A Double-Blind Trial

Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide

The Continuum of Maternal Sepsis Severity: Incidence and Risk Factors in a Population-Based Cohort Study

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