Sepsis in the Obstetric Client

Adorno, Marie

doi:10.1016/j.cnc.2018.05.012

Cited by 5 publications

(7 citation statements)

References 8 publications

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“…[ 25 ] Antepartum was defined as the initial part of pregnancy before birth and was the longest period of the 3; and infections isolated in this period showed a diversity of affected sites and types of microorganisms isolated. [ 26 ] In our study, patients with antepartum sepsis had a higher risk of septic shock, and evidence showed that all maternal deaths and most fetal deaths occurred during this period. The puerperium includes the intrapartum and postpartum periods, which is shorter than the antepartum period.…”

Section: Discussionmentioning

confidence: 56%

Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period

et al. 2022

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Maternal sepsis results in poor outcomes such as fetal or maternal death. The incidence and mortality rates of maternal sepsis vary in different places because of differences in economic development, race and medical conditions. Identifying the clinical features and determining possible mechanisms for avoiding morbidity and preventing poor outcomes would benefit committed patients. Therefore, this was an epidemiological study at a maternity transfer center in Southeast China that aimed to identify local disease features of maternal sepsis. To investigate the incidence and risk factors associated with maternal sepsis and its progression to severe sepsis in a large population-based birth cohort. This local epidemiological study was conducted in at a tertiary care center in Guangzhou, China, from 2015 to 2019. A total of 74,969 pregnant women experiencing childbirth were included in this study; Of these, 74 patients with maternal sepsis were diagnosed according to the sepsis criterion, and 118 patients without sepsis in the same period were selected randomly as the control group to study possible reasons for postpartum sepsis. This retrospective analysis covered the entire period from the first trimester to puerperium. Clinical data were collected using the hospital's electronic medical record system. Multivariate logistic regression was used to analyze risk factors for maternal sepsis. The incidences of maternal sepsis, the maternal mortality, and the fetal mortality were 0.099%, 0.004%, and 0.007%, respectively. Septic shock was associated with a higher severity of illness. All poor outcomes (maternal or fetal death) occurred during pregnancy. Postpartum sepsis had the longest onset period, and was associated with premature rupture of fetal membranes and preeclampsia. Sepsis is an important cause of both maternal and fetal mortality. Herein, we describe an epidemiological study that evaluated the incidence, development, and prognosis of local maternal sepsis. Furthermore, the characteristics of maternal sepsis are likely due to unknown pathological mechanisms, and patients would benefit from identifying more effective treatments for maternal sepsis.Abbreviations: APACHE II = acute physiology and chronic health evaluation II, BMI = body mass index, ICU = intensive care unit, IVF = in vitro fertilization, MSCs = mesenchymal stem cells, omSOFA = obstetrically modified SOFA failure assessment, PROM = premature rupture of membrane.

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Section: Discussionmentioning

confidence: 56%

Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period

et al. 2022

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“…Sepsis has significant implications for maternal health. 1 7 10 11 12 13 16 44 45 46 47 48 While obstetric-specific guidelines for other leading etiologies of maternal mortality are established, these are lacking for sepsis. As guidelines provide the foundation for approach to care, we reviewed maternal sepsis guidelines for consistency with each other and SEPSIS-3.…”

Section: Discussionmentioning

confidence: 99%

Maternal Sepsis: A Review of National and International Guidelines

2021

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Objective Sepsis is a life-threatening syndrome caused by the body's response to infection. The Global Maternal Sepsis Study (GLOSS) suggests sepsis plays a larger role in maternal morbidity and mortality than previously thought. We therefore sought to compare national and international guidelines for maternal sepsis to determine their consistency with each other and the Third International Consensus for Sepsis and Septic Shock (SEPSIS-3). Study Design Using Cochrane Database of Systematic Reviews, PubMed, Google Scholar, and organization Web sites, we identified seven guidelines on maternal sepsis in the English language—The American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Society of Obstetric Medicine of Australia and New Zealand, Royal College of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland Institute of Obstetricians and Gynaecologists, and World Health Organization. Guidelines were reviewed to ascertain the commonality and variation, if any, in definitions of maternal sepsis, tools and criteria utilized for diagnosis, obstetric warning systems used, as well as evaluation and management of maternal sepsis. These variables were also compared with SEPSIS-3. Results All guidelines provided definitions consistent with a version of the SEPSIS, although the specific version utilized were varied. Clinical variables and tools employed for diagnosis of maternal sepsis were also varied. Evaluation and management of maternal sepsis and septic shock were similar. Conclusion In conclusion, national and international maternal sepsis guidelines were incongruent with each other and SEPSIS-3 in diagnostic criteria and tools but similar in evaluation and management recommendations. Key Points

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“…No Microbiology or Infectious Disease specialists were named on the guideline development group for this document, and no Microbiology or Infectious Diseases societies were listed in the groups chosen for consultation. A review of the published literature was also performed, and five papers discussing the diagnosis of maternal sepsis were selected and reviewed [10,13,[21][22][23]: Four of these studies provided specific recommendations for microbiology specimens for diagnosis. All four studies recommended blood cultures, one as an exclusive culture test [21], another recommended a vaginal swab [10], one discussed body fluids such as urine and cerebrospinal fluid [23], and one suggesting swabs of the uterine cavity, wounds, and the cervix [22].…”

Section: Plos Onementioning

confidence: 99%

The microbial pathology of maternal perinatal sepsis: A single-institution retrospective five-year review

Powell,

Crowley,

Minihan

et al. 2023

PLoS ONE

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Introduction Greater than half of in-hospital maternal deaths are caused by sepsis, a condition that occurs when infection exceeds local tissue containment and results in organ dysfunction. Determining the source of infection can be challenging. Microbiological cultures of the uterine cavity are often difficult to obtain, so antimicrobial susceptibility results may not be available to guide treatment. The aim of this retrospective study was to assess the potential clinical value of microbiology samples used in the maternal “septic screen” of patients in an Irish maternity hospital. Methods A review was completed of all maternal “septic screen” (i.e., high vaginal swabs, placenta swabs, blood cultures, throat swabs and urine samples) microbiology results from July 2016 to December 2021. Results In the relevant period, 845 patients were subject to a “septic screen”, of whom 430 also had a placental swab collected. These 430 patients comprise our study population. 2% of blood cultures yielded potential pathogens, compared with 37%, 33%, 9% and 7% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. 95% of blood cultures were sterile, compared with 52%, 0%, 0% and 53% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. Conclusion Of the five microbiological specimen types examined, placental swabs yielded the highest number of potential pathogens. Our results suggest that placental swabs are useful specimens for detecting potential pathogens from the uterine cavity, the most common source of perinatal infections.

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Sepsis in the Obstetric Client

Cited by 5 publications

References 8 publications

Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period

Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period

Maternal Sepsis: A Review of National and International Guidelines

The microbial pathology of maternal perinatal sepsis: A single-institution retrospective five-year review

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