Incidence of maternal peripartum infection: A systematic review and meta-analysis

Abstract

BackgroundInfection is an important, preventable cause of maternal morbidity, and pregnancy-related sepsis accounts for 11% of maternal deaths. However, frequency of maternal infection is poorly described, and, to our knowledge, it remains the one major cause of maternal mortality without a systematic review of incidence. Our objective was to estimate the average global incidence of maternal peripartum infection.Methods and findingsWe searched Medline, EMBASE, Global Health, and five other databases from January 2005 to June 2016 (PROSPERO: CRD42017074591). Specific outcomes comprised chorioamnionitis in labour, puerperal endometritis, wound infection following cesarean section or perineal trauma, and sepsis occurring from onset of labour until 42 days postpartum. We assessed studies irrespective of language or study design. We excluded conference abstracts, studies of high-risk women, and data collected before 1990. Three reviewers independently selected studies, extracted data, and appraised quality. Quality criteria for incidence/prevalence studies were adapted from the Joanna Briggs Institute. We used random-effects models to obtain weighted pooled estimates of incidence risk for each outcome and metaregression to identify study-level characteristics affecting incidence. From 31,528 potentially relevant articles, we included 111 studies of infection in women in labour or postpartum from 46 countries. Four studies were randomised controlled trials, two were before–after intervention studies, and the remainder were observational cohort or cross-sectional studies. The pooled incidence in high-quality studies was 3.9% (95% Confidence Interval [CI] 1.8%–6.8%) for chorioamnionitis, 1.6% (95% CI 0.9%–2.5%) for endometritis, 1.2% (95% CI 1.0%–1.5%) for wound infection, 0.05% (95% CI 0.03%–0.07%) for sepsis, and 1.1% (95% CI 0.3%–2.4%) for maternal peripartum infection. 19% of studies met all quality criteria. There were few data from developing countries and marked heterogeneity in study designs and infection definitions, limiting the interpretation of these estimates as measures of global infection incidence. A limitation of this review is the inclusion of studies that were facility-based or restricted to low-risk groups of women.ConclusionsIn this study, we observed pooled infection estimates of almost 4% in labour and between 1%–2% of each infection outcome postpartum. This indicates maternal peripartum infection is an important complication of childbirth and that preventive efforts should be increased in light of antimicrobial resistance. Incidence risk appears lower than modelled global estimates, although differences in definitions limit comparability. Better-quality research, using standard definitions, is required to improve comparability between study settings and to demonstrate the influence of risk factors and protective interventions.

Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience

“…Apart from reducing systemic immune resistance to infection postoperatively, 11 gynecologic and genitourinary surgical procedures are known to cause postoperative bacteremia despite prophylactic antibiotics, increasing the risk of bone and joint infection. 12,13 Furthermore, pregnancy and laparoscopic surgery are associated with an increase in intra-abdominal pressure (IAP). An increase in IAP can lead to increased pressure in the venous system of the spine via valveless intraabdominal lumbar veins and increased intrathoracic pressure, causing a decrease in venous drainage from the central nervous system via the jugular system.…”

“…23 Hence, a combination of an altered immune response, postoperative bacteremia, and alteration in venous pressure gradient with the rise in IA,P which may promote the venous spread of infection, increases the risk of spinal infection in patients who have undergone nonspinal surgical procedures. [11][12][13][14]24 Our study has a few limitations. The treatment outcomes achieved in the current series at the end of 12 months need further validation in a larger study population.…”

“…11 Furthermore, gynecologic and genitourinary surgical procedures are known to cause postoperative bacteremia despite prophylactic antibiotics, increasing the risk of bone and joint infection following these procedures. 12,13 However, the literature is lacking on PS following routine elective surgical procedures, such as casar-ean delivery, ligament reconstruction, and bariatric surgery, and the treatment outcome of such patients. Hence, this study aimed to analyze the presentation and treatment outcome in patients with PS following nonspinal surgical procedures with a minimum posttreatment follow-up of 12 months.…”

Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis

“…The most common form of intrapartum infection is bacterial genito-urinary tract infection, which has an incidence of 4%. 9 Epidural hyperthermia, also known as epiduralrelated fever, refers to the situation in which a parturient who has an epidural for labour analgesia develops an elevated body temperature. 10 It was first reported in 1989 that epidural analgesia increases the risk of intrapartum hyperthermia, and over the ensuing 30 yr, this association has been extensively studied.…”

Analysis of risk factors, pathogenic bacteria of maternal sepsis in term pregnant women with positive blood culture during hospitalization

“…[ 1 ] Maternal sepsis ranks the third most common direct cause of maternal mortality following maternal hemorrhage and maternal hypertension in Asia. [ 2 , 3 ] Death incidence rates of maternal sepsis in a country varies by development stages. Compared with developed countries, sepsis was significantly more frequent in Africa, Asia, Latin America, and Caribbean.…”