Susan Sellers (St Michael's Hospital, Bristol), Colleen Acosta-Nielsen (NPEU (Former member)), Peter Brocklehurst (NPEU), Jenny Kurinczuk (NPEU)
Severe maternal morbidity and mortality
National Institute for Health Research
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.