DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204807

Maternal sepsis- an audit in a tertiary care center in South India

Roopa P. Shivananda, Gurram Bhanuteja, Shubha Rao, Nivedita Hegde, Sangamithra Paladugu, Akhila Vasudeva

Abstract


Background: Objective of this study was to audit the cases of maternal sepsis and analyze their maternal and fetal outcomes.

Methods: A retrospective analysis of cases of maternal sepsis was undertaken for one year. Cases were taken as infection with fever, tachycardia, tachypnea, low oxygen saturation, high or low white blood counts and clinical or laboratory evidence of organ dysfunction and were analyzed. Demographic profile, gestational age at the time of diagnosis, organisms & their sources of infection was noted. Maternal outcomes of abortion, preterm delivery, need for intensive care unit (ICU) / high dependency unit (HDU) stay, blood and blood products, surgical interventions for the control of infection, culture-positive rate, source of organism, antibiotic usage and maternal mortality were analyzed. Fetal outcomes of early fetal demise, preterm birth, intrauterine death, stillbirth and term birth were studied.  

Results: There were a total of 2327 deliveries, with 2333 live births during the study period. Twenty-two cases were diagnosed with sepsis, of which 17 survived, and five died. The incidence of maternal sepsis was 9.4/1000 live births & maternal deaths were 22.7%. Ninety percent were in the age group of 21-39 years, 68% were referred, 59% were post-delivery. Fifty nine percent of women who survived, and none of the women who died had medical co-morbidities. Respiratory tract followed by genitourinary tract were the most common source of infection, though culture was negative in 54.5% of the cases. The organisms grown were varied, with Escherichia coli (3/10) contributing to 30% of the culture positive cases. Spontaneous abortion and preterm delivery were 18% each, 36% required surgical intervention, 81% required ICU and 64.7% HDU stay. Seventy-seven had live birth.

Conclusions: Maternal sepsis is an evolving preventable health burden. Early recognition requires a high index of clinical suspicion, even in the absence of risk factors. Mortality to morbidity ratio is very high in maternal sepsis. The timing of sepsis determines the fetal outcomes.


Keywords


Maternal sepsis, Septic shock, Organ dysfunction, Maternal mortality, Sequential organ failure assessment score

Full Text:

PDF

References


Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Heal. 2014;

Bonet M, Nogueira Pileggi V, Rijken MJ, Coomarasamy A, Lissauer D, Souza JP, et al. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation. Reprod Health. 2017;14(1):1–13.

Enquiries C. Saving Mothers’ Lives. 2011;118:2006–8.

Acosta CD, Knight M, Lee HC, Kurinczuk JJ, Gould JB, Lyndon A. The Continuum of Maternal Sepsis Severity: Incidence and Risk Factors in a Population-Based Cohort Study. PLoS One. 2013;8(7):1–8.

Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Che. 2011.

Bonet M, Brizuela V, Abalos E, Cuesta C, Baguiya A, Chamillard M, et al. Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lanc Glob Heal. 2020;8(5):e661–71.

Turner MJ. Maternal sepsis is an evolving challenge. Int J Gynecol Obstet. 2019;146(1):39–42.

Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: Temporal trends and independent associations for severe sepsis. In: Anesthesia and Analgesia. 2013.

World Health Organization. Statement on Maternal Sepsis Sepsis: a leading cause of maternal deaths. Dep Reprod Heal Res World Heal Organ. 2017;1–4. Available at: http://apps.who.int/iris/bitstream /10665/254608/1/WHO-RHR-17.02-eng.pdf. Accessed on 05 May 2020.

Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). J Am Med Assoc. 2016;315(8):801–10.

Ekele BA, Audu LR. Gestation age at antenatal clinic booking in Sokoto, northern Nigeria. Afr J Med Med Sci. 1998;27(3–4):161–3.

Liabsuetrakul T. Is international or Asian criteria-based body mass index associated with maternal anaemia, low birthweight, and preterm Births among Thai population?—an observational study. J Heal Popul Nutrit. 2011;29(3):218.

Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M. Maternal sepsis : a Scottish population-based case – control study. 2012;474–83.

Kramer HM, Schutte JM, Zwart JJ, Schuitemaker NW, Steegers EA, Van Roosmalen J. Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta obstetric Gynecolog Scandin. 2009;88(6):647-53.

Barton JR. Severe Sepsis and Septic Shock in Pregnan. 2012;120(3):689–706.

1Plante LA, Pacheco LD, Louis JM. SMFM Consult Series 47: Sepsis during pregnancy and the puerperium. Am J Obstet Gynecol. 2019;220(4):B2–10.

Timezguid N, Das V, Hamdi A, Ciroldi M, Sfoggia-Besserat D, Chelha R, et al. Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission. Int J Obstet Anesth. 2012;21(1):51–5.

Drew RJ, Fonseca-Kelly Z, Eogan M. A Retrospective Audit of Clinically Significant Maternal Bacteraemia in a Specialist Maternity Hospital from 2001 to 2014. Infect Dis Obstet Gynecol. 2015;2015.

Acosta CD, Knight M. Sepsis and maternal mortality. Curre Opin Obstet Gynecol. 2013.

Knowles SJ, O’Sullivan NP, Meenan AM, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: A prospective study. Int J Obstet Gynaecol. 2015;

Pundir J, Coomarasamy A, Pundir J, Coomarasamy A. Bacterial sepsis in pregnancy. Obstet Evidence-Based Algorithms. 2016;(64):87–9.

Greer O, Shah NM, Johnson MR. Maternal sepsis update: current management and controversies. Obstet Gynaecol. 2020;22(1):45–55.

No G. Bacterial Sepsis following Pregnancy Green-top Guideline No. 64b. 2012;(64):21.

WHO. WHO recommendations for prevention and treatment of maternal peripartum infections. Available at: https://www.who.int/reproductive health/publications/maternal_perinatal_health/peripartum-infections-guidelines/en/. Accessed on 20 May 2020.

The Global Maternal and Neonatal Sepsis Initiative: WHO [Internet]. Available at: https://srhr.org/sepsis/. Accessed on 04 June 2020.

Goldenbrg RL, McClure EM, Saleem S, Reddy UM. Infection-related stillbirths. Lanc. 2010;375(9724):1482–90.

Article O. Incidence, treatment and outcome of peripartum sepsis. 2003;82:730–5.

Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552.

Klompas M, Calandra T, Singer M. Antibiotics for Sepsis - Finding the Equilibrium. J Americ Medic Assoc. 2018;320:1433–4.

Knight M, Chiocchia V, Partlett C, Rivero-Arias O, Hua X, Hinshaw K, et al. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial. Lanc. 2019;393(10189):2395-403.

Brizuela V, Bonet M, Souza JP, Tunçalp Ö, Viswanath K, Langer A. Factors influencing awareness of healthcare providers on maternal sepsis: A mixed-methods approach. BMC Pub Heal. 2019;19(1):1–11.