Maternal mortality and severe morbidity from sepsis in the Netherlands

Kramer, Hannah M.C.; Schutte, Joke M.; Zwart, Joost J.; Schuitemaker, Nico; Steegers, Eric A.P.; Roosmalen, Jos van

doi:10.1080/00016340902926734

Cited by 102 publications

(135 citation statements)

References 20 publications

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“…These include studies of sepsis in obstetric populations,6, 9, 10, 11, 30 and other morbidities in obstetric populations 12, 13, 14, 27, 31, 32. Interestingly, all those studies found an effect of at least one socio‐demographic factor, most commonly age, body mass index (BMI) or ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

Mohamed-Ahmed

Nair

Acosta

et al. 2015

BJOG

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ObjectiveTo identify factors associated with progression from pregnancy‐associated severe sepsis to death in the UK.DesignA population‐based case‐control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).SettingAll pregnancy care and death settings in UK hospitals.PopulationAll non‐influenza sepsis‐related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non‐influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358).MethodsCases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals.Main outcome measuresOdds ratios for socio‐demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.ResultsFour factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64–141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23–5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62–7.89). Anaemia (aOR = 13.5, 95%CI 3.17–57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93–116.9) were the two most important factors driving the association between medical comorbidities and progression to death.ConclusionsThere must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis‐related maternal deaths.Tweetable abstractMedical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.

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Section: Discussionmentioning

confidence: 99%

Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis

Mohamed-Ahmed

Nair

Acosta

et al. 2015

BJOG

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“…17 However, the maternal CFR from severe sepsis can be higher as in the Netherlands where it was 7.7% and the maternal mortality rate from sepsis was Group A Streptococcal Infections 867 0.7 per 100,000 live births. 5 Today, GAS produces a substantial amount, from 40% to over 50%, of maternal mortality related to sepsis in developed countries. 5,18 Over 80% of the neonates of women with invasive GAS infection remained well, and whereas no neonatal deaths occurred, septic abortion, abortion, and stillbirth occurred among women with invasive GAS.…”

Section: Epidemiologymentioning

confidence: 99%

“…5 Today, GAS produces a substantial amount, from 40% to over 50%, of maternal mortality related to sepsis in developed countries. 5,18 Over 80% of the neonates of women with invasive GAS infection remained well, and whereas no neonatal deaths occurred, septic abortion, abortion, and stillbirth occurred among women with invasive GAS. 18…”

Section: Epidemiologymentioning

confidence: 99%

“…Today, although invasive GAS infection is infrequent in developed countries, it still causes of about 40% of septic deaths among patients with postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome (TSS) infection. 5 Microbiology GAS is a facultative, gram-positive coccus that causes numerous infections including pharyngitis, tonsillitis, scarlet fever, erysipelas, cellulitis, lymphangitis, necrotizing fasciitis, myonecrosis, TSSs, and the postinfection complications that include rheumatic fever and poststreptococcal glomerulonephritis. The only known reservoir for GAS is the skin and mucous membranes of humans.…”

Section: Introductionmentioning

confidence: 99%

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Group A Streptococcal Infections in Obstetrics and Gynecology

Rimawi

Soper

Eschenbach

2012

Clinical Obstetrics &Amp; Gynecology

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Group A streptococcal (GAS) infections continue to be an infrequent, but potentially lethal infections in women despite the victory over childbed fever in the 1800s. Invasive group A streptococcal infection still causes 40% of septic deaths among patients with postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome. Many times symptoms and signs of this infection are nonspecific, but laboratory evaluation can suggest serious infection. The prudent combination of antibiotic and surgical therapy can be lifesaving.

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“…Then bacteria are able to reproduce and reach numbers in excess of 10 5 per milliliter of amniotic fluid 27 . Risk factors for the development of maternal sepsis include home birth in unhygienic conditions, low socioeconomic status, poor nutrition, primiparity, anaemia, prolonged rupture of membranes, prolonged labour, multiple vaginal examinations in labour (more than five), caesarean section, multiple pregnancy, artificial reproductive techniques, overweight and obstetrical manoeuvres 14,28 .…”

Section: Risk Factors and Routes Of Infection In Pregnancymentioning

confidence: 99%