Sepsis: Precision-Based Medicine for Pregnancy and the Puerperium

Greer, Orene; Shah, Nishel Mohan; Sriskandan, Shiranee; Johnson, Mark R.

doi:10.3390/ijms20215388

Cited by 21 publications

(19 citation statements)

References 111 publications

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“…A bedside tool for the prognosis and diagnosis of sepsis was validated in the general population, and awareness of sepsis was increased by several campaigns [25,26]. However, pregnancy-specific management is based on those developed for the nonpregnant population, and the diagnosis of sepsis is still difficult due to physiological changes in pregnancy [4,27,28]. Given these challenges, improvements in sepsisrelated mortality in the general population may not be observed among pregnant women.…”

Section: Discussionmentioning

confidence: 99%

“…Maternal sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infections during pregnancy, childbirth, post-abortion or the postpartum period [3]. Infection, especially sepsis contributes significantly to global morbidity and mortality, particularly in vulnerable populations [4]. Maternal infections can have serious considerable impacts on the health of women and neonates.…”

Section: Introductionmentioning

confidence: 99%

“…For women, maternal infections can cause chronic pelvic inflammatory disease, ectopic pregnancy, infertility and death [5]. Annually, one million neonatal deaths are attributed to maternal infections or sepsis [4,6,7]. Infections or sepsis are preventable causes of maternal morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…(See figure on next page.) Fig 4. The age-standardized rate of MSMI in 204 countries and territories in 2019.…”

mentioning

confidence: 99%

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The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Chen¹,

Wang

Gao³

et al. 2021

BMC Infect Dis

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Background Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures. Methods Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters. Results Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions. Conclusion These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…(See figure on next page.) Fig 4. The age-standardized rate of MSMI in 204 countries and territories in 2019.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Chen¹,

Wang

Gao³

et al. 2021

BMC Infect Dis

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“…For the analysis of maternal sepsis in our location, this retrospective study focused on characteristic and associated factors of maternal sepsis. According to the latest de nitions and classi cations of sepsis, the diagnoses were sepsis and septic shock [1], as well as maternal sepsis [11]. Sepsis-induced shock is characterized by severe clinical symptoms and poor outcomes, and the clinical symptoms could be evaluated by the obstetric-modi ed quick sequential organ failure assessment (omSOFA) score [12] and the acute physiology and chronic health evaluation II (APACHE II) score [13].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Clinical Features of Maternal Sepsis：A Retrospective Study of Whole Pregnancy Period

Zhong

Lin

Zhang

et al. 2021

Preprint

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Background: Maternal sepsis results in poor outcomes such as fetal or maternal death. The incidence and mortality rates of maternal sepsis are variable in different places because of differences in economic development, race, medical conditions, etc. Identifying the clinical features and determining the possible mechanisms for avoiding morbidity and preventing poor outcomes would benefit committed patients. Therefore, this study was an epidemiological study at a maternity transfer centre in Southeast China that aimed to identify local disease features of maternal sepsis.Methods: This was a local epidemiological study in at a tertiary care center in Guangzhou, China, from 2015 to 2019. A total of 74969 pregnant women experiencing childbirth were included in this study; of these women, 74 patients with maternal sepsis were diagnosed by 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 experiment covers the whole period from first trimester to puerperium. The clinical data were collected via the hospital electronic medical record system. Single-factor regression and multivariate logistic regression were implemented to analyze the risk factors for maternal sepsis.Results: The incidence of maternal sepsis was 0.099%, the maternal mortality ratio was 0.004% and the fetal mortality ratio was 0.007%. For clinical manifestations, septic shock was associated with a higher severity of patient illness. All of the poor outcomes (maternal or fetal death) occurred during pregnancy. Postpartum sepsis had the longest onset period, and postpartum sepsis was associated with the premature rupture of fetal membranes and preeclampsia.Conclusions: Maternal sepsis is an important cause of both maternal and fetal mortality. Here we described an epidemiological study that evaluated the disease incidence, development and prognosis of local maternal sepsis. Furthermore, the characteristics of maternal sepsis is likely due to unknown pathological mechanisms, and patients would benefit from the identification of more effective treatments for maternal sepsis.

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