Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis

Shields, Andrea; Assis, Viviana de; Halscott, Torre

doi:10.1097/aog.0000000000004471

Cited by 35 publications

(52 citation statements)

References 86 publications

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“…The burden of maternal sepsis has increased over time. 2,[8][9] Early intervention is key to reducing maternal morbidity. However, many with maternal sepsis experience delayed care.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…However, none have been externally validated or designed specifically to detect organ dysfunction consistent with maternal sepsis. 2,25,[28][29] There are several strengths of our study. The SAAP score was developed from a study of pregnant and postpartum individuals aiming to identify CMAO due to infection.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…for infection, and of maternal infections has only been validated for chorioamnionitis. 2,29 Additionally, both SOS and omqSOFA are adaptions of general population tools later applied to the obstetric population. [26][27] Another important distinction of the SAAP score is its objective to identify individuals at risk of adverse outcomes almost exclusively consistent with SEPSIS-3.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

et al. 2022

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Objective: To develop and evaluate a scoring system—called Sepsis-Associated Adverse Outcomes in Pregnancy (SAAP) Score—to identify individuals with maternal infection that have composite maternal adverse outcomes (CMAO). Study Design: Using ICD codes, we identified pregnant and postpartum (up to 6 weeks after birth) individuals admitted at our center with a primary diagnosis of infection. The primary outcome was CMAO, which included any of the following: maternal intensive care unit admission, surgical intervention, vasopressor use, acute respiratory distress syndrome, pulmonary edema, mechanical ventilation, high flow nasal cannula, disseminated intravascular coagulation, dialysis, organ failure, venous thromboembolism, or maternal death. Regularized logistic regression was used to identify variables that best discriminate CMAO status. Variables were chosen for inclusion following evaluation of statistical and clinical significance. Model performance was evaluated using area under the curve (AUC) with 95% confidence intervals (CI), sensitivity, specificity, and predictive values. Results: Of the 23,235 deliveries during the study period, 227 (0.9%) individuals met inclusion criteria and among them CMAO occurred in 39.2% (95% CI 33.1% to 45.7%). The SAAP score consisted of 6 variables (white blood cell count, systolic blood pressure, respiratory rate, heart rate, lactic acid, and abnormal diagnostic imaging) with scores ranging from 0 to 11 and a score  7 being abnormal. An abnormal SAAP score had an AUC of 0.80 (95% CI 0.74-0.86) for CMAO. The sensitivity and specificity of the SAAP score for CMAO was 0.71 (95% CI 0.60 to 0.80) and 0.73 (95% CI 0.64 to 0.80), respectively. The positive predictive value was 0.62 (95% CI 0.52 to 0.72) and negative predictive value, 0.79 (95% CI 0.71 to 0.86). Conclusion: Pending external validation, the 6 variable SAAP score, may permit early recognition of pregnant and postpartum individuals with infection who are likely to develop adverse maternal outcomes.

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“…The burden of maternal sepsis has increased over time. 2,[8][9] Early intervention is key to reducing maternal morbidity. However, many with maternal sepsis experience delayed care.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

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Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

et al. 2022

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“…Chorioamnionitis has significant implications for both mother and fetus. In the mother, sepsis can ensue culminating in intensive care admission and maternal death 4 . Although all fetuses born extremely preterm are at higher risk of mortality, 5 respiratory, neurological and gastroenterological morbidity, these risks are increased in the presence of chorioamnionits 6–8 .…”

Section: Introductionmentioning

confidence: 99%

Antenatal diagnosis of chorioamnionitis: A review of the potential role of fetal and placental imaging

et al. 2022

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Chorioamnionitis is present in up to 70% of spontaneous preterm births. It is defined as an acute inflammation of the chorion, with or without involvement of the amnion, and is evidence of a maternal immunological response to infection. A fetal inflammatory response can coexist and is diagnosed on placental histopathology postnatally. Fetal inflammatory response syndrome (FIRS) is associated with poorer fetal and neonatal outcomes. The only antenatal diagnostic test is amniocentesis which carries risks of miscarriage or preterm birth. Imaging of the fetal immune system, in particular the thymus and the spleen, and the placenta may give valuable information antenatally regarding the diagnosis of fetal inflammatory response.While ultrasound is largely limited to structural information, MRI can complement this with functional information that may provide insight into the metabolic activities of the fetal immune system and placenta. This review discusses fetal and placental imaging in pregnancies complicated by chorioamnionitis and their potential future use in achieving non-invasive antenatal diagnosis. Key points What's already known about the topic?� Chorioamnionitis is present in up to 70% of spontaneous preterm births and is associated with more complications than unaffected spontaneous preterm births � Diagnosis is postnatal. Antenatal diagnosis by amniocentesis carries a risk of preterm birth, and is not integrated into clinical care What does this review add?� Ultrasound assessment of the fetal immune system gives structural information and limited functional information, while MRI can complement this with greater functional tissue information � Imaging may play a role in the non-invasive antenatal diagnosis of chorioamnionitisThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…These include the Sequential Organ Failure Assessment (SOFA) score, the “quick” or qSOFA, and the modified Early Warning Signs Score. 5 Data are limited in this context when it comes to pregnancy. However, there have been modified scoring systems that take into account clinical characteristics of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Inpatient Management and OBICU Care for Pregnant Patients With Severe COVID-19 Disease

Vaught¹

2022

Clinical Obstetrics &Amp; Gynecology

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Top 10 Pearls for the Recognition, Evaluation, and Management of Maternal Sepsis

Abstract: Personal or nonessential information may be redacted at the editor's discretion.

Cited by 35 publications

References 86 publications

Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

Antenatal diagnosis of chorioamnionitis: A review of the potential role of fetal and placental imaging

Inpatient Management and OBICU Care for Pregnant Patients With Severe COVID-19 Disease

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