Maternal sepsis in pregnancy and the puerperal periods: a cross-sectional study

Abstract

Maternal sepsis is a life-threatening condition and ranks among the top five causes of maternal death in pregnancy and the postpartum period. Herein, we conducted a retrospective study on sepsis cases to explain the related risk factors by comparing them with bloodstream infection (BSI) and control maternities. In total, 76 sepsis cases were enrolled, and 31 BSI and 57 maternal cases of the same age but with neither sepsis nor BSI were set as controls. Genital tract infection (GTI) and pneumonia were the two most common infection sources in both sepsis (22 cases, 29% and 29 cases, 38%) and BSI cases (18 cases, 58% and 8 cases, 26%). Urinary tract infection (UTI)/pyelonephritis (9 cases, 12%) and digestive infection cases (11 cases, 14%) only existed in the sepsis group. Significantly different infection sources were discovered between the sepsis-death and sepsis-cure groups. A higher proportion of pneumonia and a lower proportion of GTI cases were present in the sepsis-death group (17 cases, 45% pneumonia and 9 cases, 24% GTI) than in the sepsis-cure group (12 cases, 32% pneumonia and 13 cases, 34% GTI). In addition, although gram-negative bacteria were the dominant infectious microorganisms as previously reported, lower proportion of gram-negative bacteria infectious cases in sepsis (30 cases, 50%) and even lower in sepsis-death group (14 cases, 41%) was shown in this study than previous studies. As expected, significantly greater adverse maternal and fetal outcomes, such as higher maternal mortality (26.3% vs. 0% vs. 0%), higher fetal mortality (42.2% vs. 20.8% vs. 0%), earlier gestational age at delivery (26.4 ± 9.5 vs. 32.3 ± 8.1 vs. 37.7 ± 4.0) and lower newborn weight (1,590 ± 1287.8 vs. 2859.2 ± 966.0 vs. 3214.2 ± 506.4), were observed in the sepsis group. This study offered some potential pathogenesis and mortality risk factors for sepsis, which may inspire the treatment of sepsis in the future.

Keywords: infection; maternal and fetal outcome; maternal sepsis; obstetrical critical illness; organ failure.

Figure 1

The workflow of case collection in this study. The collection period can be divided into two stages, including stage I (2000–2021) and stage II (2010–2021). During stage I, only maternal sepsis death cases were collected, and 28 sepsis death cases from 12 hospitals in China were enrolled in total. For stage II, 48 symptomatic cases of maternal sepsis were collected, among which 38 cases were cured and 10 died. In addition, 31 patients with bloodstream infections (BSIs) and 57 maternal cases of the same age who were diagnosed with neither sepsis nor BSI were enrolled as the control groups.

Figure 2

The infection sources were significantly different between the sepsis and BSI groups, as well as between the sepsis-cure and sepsis-death groups. UTI/pyelonephritis and digestive infection showed significantly higher frequency in sepsis patients than in BSI patients, while significantly more genital tract infection cases were shown in BSI patients. Pneumonia may be a risk factor for death in sepsis patients. The case number and ratio are labeled in the figure. p-values with significant changes are marked as red text. The types of diseases included in each group are presented in Supplementary Table S1.

Figure 3

The percentages of gram-positive bacteria and fungi cultured from sepsis patients were both higher than those from the BSI group and higher from the sepsis-death group than from the sepsis-cure group. Microorganism numbers and ratios were labeled. No significant difference was detected between the groups. Detailed information on the cultivated microorganisms is presented in Supplementary Table S2.