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. 2015 Oct;122(11):1506-15.
doi: 10.1111/1471-0528.13551. Epub 2015 Jul 22.

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

O Mohamed-Ahmed  1 , M Nair  1 , C Acosta  1 , J J Kurinczuk  1 , M Knight  1
Affiliations

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

O Mohamed-Ahmed et al. BJOG. 2015 Oct.

Abstract

Objective: To identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK.

Design: A population-based case-control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).

Setting: All pregnancy care and death settings in UK hospitals.

Population: All 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).

Methods: Cases 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 measures: Odds ratios for socio-demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.

Results: Four 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.

Conclusions: There 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 abstract: Medical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.

Keywords: Maternal deaths; maternal sepsis; pregnancy; septic shock; severe acute maternal morbidity; severe sepsis.

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Figure 1
Time delay from diagnosis to administration of antibiotics, in cases only.
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References

    1. Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk J, et al. Saving Lives, Improving Mothers' Care—Lessons Learned to Inform Future Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2014.
    1. Cantwell R, Clutton‐Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG 2011;118(Suppl 1):1–203. - PubMed
    1. Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol 2010;63:425–33. - PMC - PubMed
    1. Filippi V, Alihonou E, Mukantaganda S, Graham WJ, Ronsmans C. Near misses: maternal morbidity and mortality. Lancet 1998;351:145–6. - PubMed
    1. Say L, Souza JP, Pattinson RC, Mortality WHO, Working Group on Maternity and Morbidity classification . Maternal near miss—towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol 2009;23:287–96. - PubMed

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