Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.

Objective: To describe risk factors and outcomes of pregnant women infected with SARS-CoV-2 admitted to South African healthcare facilities. Methods:A population-based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS-CoV-2 infection, hospitalized between April 14, 2020, and November 24, 2020, were analyzed.Results: A total of 36 hospitals submitted data on 673 infected hospitalized pregnant women; 217 (32.2%) were admitted for COVID-19 illness and 456 for other indications. There were 39 deaths with a case fatality rate of 6.3%: 32 (14.7%) deaths occurred in women admitted for COVID-19 illness compared to 7 (1.8%) in women admitted for other indications. Of the women, 106 (15.9%) required critical care.Maternal tuberculosis, but not HIV co-infection or other co-morbidities, was associated with admission for COVID-19 illness. Rates of cesarean delivery did not differ significantly between women admitted for COVID-19 and those admitted for other indications. There were 179 (35.4%) preterm births, 25 (4.7%) stillbirths, 12 (2.3%) neonatal deaths, and 162 (30.8%) neonatal admissions. Neonatal outcomes did not differ significantly from those of infected women admitted for other indications. Conclusion:The maternal mortality rate was high among women admitted with SARS-CoV-2 infection and higher in women admitted primarily for COVID-19 illness with tuberculosis being the only co-morbidity associated with admission.

Summary Background Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. Methods GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. Findings We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1·84 [95% CI 1·05–3·22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2·44 [1·02–5·85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). Interpretation While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection...

Objective: To assess feasibility and acceptability of a novel, low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH). Methods:We allocated patients with refractory PPH by randomly ordered envelopes to STUT or routine uterine balloon tamponade (UBT, Ellavi free-flow system) in 10 hospitals in South Africa. In the STUT group, a 24FG Levin stomach tube was inserted into the uterine cavity and vacuum created with a vacuum pump or manual vacuum aspiration syringe.

Acute and intentional poisoning is one of the most common reasons why pregnant and non-pregnant patients present to the emergency department of a health service. Young patients are most commonly affected, with a high mortality rate. In most instances, the ingested agent(s) is unknown. Only the victim knows what happened, and at presentation they might be unable to communicate the information. The first responder is the second-best person to identify the poison, which rarely occurs. Agitation that progresses to central nervous system depression and subsequent coma is common in the majority of toxin cases. The files of women classified as coincidental deaths by the National Committee on Confidential Enquiries into Maternal Deaths were examined to establish if those who might have died from poisoning could be identified. Some examples are presented. Organophosphate ingestion appeared to be a fairly common cause of poisoning that resulted in maternal deaths. Signs and symptoms of such poisoning are discussed. Case 1 A teenage primigravida presented to her local clinic during the first trimester of pregnancy, requesting termination of pregnancy (TOP). No management plan was prepared regarding her request, despite repeated visits. She was also HIV-positive, her CD4 count was unknown and she started antiretroviral treatment. Three months later the acutely ill patient presented at a tertiary hospital and was admitted to the antenatal ward. She was administered fluids and antibiotics, but she progressively deteriorated. She was then transferred to a high-dependency ward and died within an hour of admission from multi-organ (renal, respiratory, haematological and metabolic) failure secondary to suspected poisoning. Lessons learnt • Take requests for TOP seriously, construct clear management plans and document them. Involve a social worker. • Do not underestimate the clinical condition of a patient in respiratory distress. Case 2 A teenage primigravida who had not attended antenatal care was admitted to a district hospital 6 hours after taking an overdose of a known substance. She was clinically in shock and was admitted for 3 days; her condition became progressively worse. She died on the third day while waiting for a transfer to a higher level of care. During the time at the district hospital, she mainly received nursing care and occasional telephonic advice from a doctor. Lessons learnt • Do not delay referral of critically ill patients. • Request doctors to personally review ill patients. Case 3 A young woman in her early twenties, who previously delivered a baby by caesarean section, was now in her third trimester and received no antenatal care. She was found dead at home after carbamate ingestion. Lesson learnt • Emphasise the importance of (long-acting) contraception post partum and during every contact with the health system. Case 4 A 20-year-old pregnant woman who had not attended antenatal care This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.