Surveillance of severe maternal sepsis

Summary

Key points

• Maternal death from sepsis is increasing in countries with advanced healthcare systems. Sepsis is now the leading cause of direct maternal death in the UK.
• The objectives of this national prospective case-control study were to estimate the incidence, describe the causative organisms and sources of infection, and identify the risk factors for severe maternal sepsis in the UK.
• There were 365 confirmed cases of severe maternal sepsis between June 2011 and May 2012, an incidence of 4.7 (95% CI 4.2–5.2) per 10,000 maternities; 71 (19.5%) women developed septic shock; and five (1.4%) women died.
• Genital tract infection (31.0%) and the organism E coli (21.1%) were most common.
• Women had significantly increased adjusted odds of severe sepsis if they were black or other ethnic minority (aOR = 1.82; 95% CI 1.82–2.51), were primiparous (aOR = 1.60; 95% CI 1.17–2.20), had a pre-existing medical problem (aOR = 1.40; 95% CI 1.005–1.94), had febrile illness or were taking antibiotics in the two weeks prior to presentation (aOR = 12.07; 95% CI 8.11–17.97).
• All forms of operative delivery were associated with increased risk of sepsis.
• Multiple pregnancy (aOR = 5.75; 95% CI 1.54–21.45) and infection with group A streptococcus (aOR = 4.84; 2.17–10.78) were associated with progression to septic shock.
• This study suggests that for each maternal sepsis death, approximately 50 women have life threatening morbidity from sepsis. Follow-up to ensure infection is eradicated is important.
• The rapid progression to severe sepsis highlights the importance of following the international Surviving Sepsis Campaign guideline of early administration of high-dose intravenous antibiotics within one hour of admission to hospital for any woman with suspected sepsis.
• Signs of severe sepsis in peripartum women, particularly with confirmed or suspected group A streptococcal infection, should be regarded as an obstetric emergency.

Publications

Journal Articles

• Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M. Maternal sepsis: a Scottish population-based case?control study. Br J Obstet Gynaecol. 2012;119(4):474-83.
• Acosta CD, Knight M. Sepsis and maternal mortality. Curr Opin Obstet Gynaecology. 2013;25(2):109-16.
• Acosta CD, Kurinczuk JJ, Lucas DN, Tuffnell DJ, Sellers S, Knight M, United Kingdom Obstetric Surveillance System. Severe maternal sepsis in the UK, 2011-2012: a national case-control study. PLoS Med. 2014;11(7):e1001672.
• Kalin A, Acosta C, Kurinczuk JJ, Brocklehurst P, Knight M. Severe sepsis in women with group B Streptococcus in pregnancy: an exploratory UK national case?control study. BMJ open. 2015;5(10):e007976.
• Mohamed-Ahmed O, Nair M, Acosta C, Kurinczuk JJ, Knight M. Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis. BJOG. 2015;122(11):1506.