2018
DOI: 10.1371/journal.pone.0200281
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The golden hour of sepsis: An in-depth analysis of sepsis-related maternal mortality in middle-income country Suriname

Abstract: BackgroundSepsis was the main cause of maternal mortality in Suriname, a middle-income country. Objective of this study was to perform a qualitative analysis of the clinical and management aspects of sepsis-related maternal deaths with a focus on the ‘golden hour’ principle of antibiotic therapy.MethodsA nationwide reproductive age mortality survey was performed from 2010 to 2014 to identify and audit all maternal deaths in Suriname. All sepsis-related deaths were reviewed by a local expert committee to assess… Show more

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Cited by 22 publications
(27 citation statements)
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“…We also acknowledge that the evaluation surveys were not conducted by an independent party and may not have captured all the dimensions of the development process. Nevertheless, if the incidence of maternal mortality and severe morbidity declines, the awareness created among healthcare providers by recent publications on local maternal mortality in Suriname together with the development of the guidelines will likely have contibuted, especially as no other major interventions related to HDP and PPH have taken place the past decade [11, 13]. In the context of research, we are evaluating implementation of the guidelines by criteria-based audits embedded in a prospective cohort study on severe maternal morbidity and mortality due to HDP and PPH, currently ongoing in Suriname.…”
Section: Discussionmentioning
confidence: 99%
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“…We also acknowledge that the evaluation surveys were not conducted by an independent party and may not have captured all the dimensions of the development process. Nevertheless, if the incidence of maternal mortality and severe morbidity declines, the awareness created among healthcare providers by recent publications on local maternal mortality in Suriname together with the development of the guidelines will likely have contibuted, especially as no other major interventions related to HDP and PPH have taken place the past decade [11, 13]. In the context of research, we are evaluating implementation of the guidelines by criteria-based audits embedded in a prospective cohort study on severe maternal morbidity and mortality due to HDP and PPH, currently ongoing in Suriname.…”
Section: Discussionmentioning
confidence: 99%
“…Similar to most LMICs, the primary causes of maternal deaths in Suriname are postpartum hemorrhage (PPH) and hypertensive disorders of pregnancy (HDP) [11]. The majority of these deaths are due to ‘third delay’ factors linked to the quality of care, such as in-hospital delay of diagnosis and treatment [11, 13]. The introduction of nationwide guidelines for the clinical management of these complications is therefore a promising strategy to improve health outcomes.…”
Section: Introductionmentioning
confidence: 99%
“…Delay in the administration of effective antibiotics is associated with a measurable increase in mortality in patients with septic shock [14,15]. The Surviving Sepsis Campaign guidelines 2012 recommend effective antibiotics within an hour of diagnosis of severe sepsis or septic shock [16].…”
Section: Introductionmentioning
confidence: 99%
“…Positive outcomes are highly related to effective management in prehospital settings and emergency departments (ED), since successful treatment is time-dependent [20]. Although recommendations for management of the patients are suggesting consideration of "golden hour" and "silver day, " representing the first few hours of disease presentation and the few remaining hours of the first day, respectively, transferring the patient from the ED to an ICU is often not performed in a timely manner [21][22][23]. Clinicians face a challenge in differentiating sepsis from other acute conditions due to similarities with signs or symptoms for other common diseases.…”
Section: Introductionmentioning
confidence: 99%