Dataset Information

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

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.

SUBMITTER: Mohamed-Ahmed O

PROVIDER: S-EPMC5008196 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Publications

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

Mohamed-Ahmed O O Nair M M Acosta C C Kurinczuk J J JJ Knight M M

BJOG : an international journal of obstetrics and gynaecology 20150722 11

<h4>Objective</h4>To identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK.<h4>Design</h4>A population-based case-control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).<h4>Setting</h4>All pregnancy care and death settings in UK hospitals.<h4>Population</h4>All non-influenza sepsis-related maternal deaths (January 2009 to December 2012) were included as cases (n = 4 ...[more]

PMID: 26213333

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Project description:In light of increasing rates and severity of sepsis worldwide, this study aimed to estimate the incidence of, and describe the causative organisms, sources of infection, and risk factors for, severe maternal sepsis in the UK.A prospective case-control study included 365 confirmed cases of severe maternal sepsis and 757 controls from all UK obstetrician-led maternity units from June 1, 2011, to May 31, 2012. Incidence of severe sepsis was 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 Escherichia coli (21.1%) were most common. Women had significantly increased adjusted odds ratios (aORs) 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 1.01-1.94), had febrile illness or were taking antibiotics in the 2 wk prior to presentation (aOR?=?12.07; 95% CI 8.11-17.97), or had an operative vaginal delivery (aOR?=?2.49; 95% CI 1.32-4.70), pre-labour cesarean (aOR?=?3.83; 95% CI 2.24-6.56), or cesarean after labour onset (aOR?=?8.06; 95% CI 4.65-13.97). Median time between delivery and sepsis was 3 d (interquartile range?=?1-7 d). 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; for 16 (50%) women with a group A streptococcal infection there was <2 h-and for 24 (75%) women, <9 h-between the first sign of systemic inflammatory response syndrome and a diagnosis of severe sepsis. A limitation of this study was the proportion of women with sepsis without an identified organism or infection source (16.4%).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 1 h of admission to hospital for anyone 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. Please see later in the article for the Editors' Summary.

Project description:ObjectiveTo investigate the factors associated with maternal death from direct pregnancy complications in the UK.DesignUnmatched case-control analysis.SettingAll hospitals caring for pregnant women in the UK.PopulationA total of 135 women who died (cases) between 2009 and 2012 from eclampsia, pulmonary embolism, severe sepsis, amniotic fluid embolism, and peripartum haemorrhage, using data from the Confidential Enquiry into Maternal Death, and another 1661 women who survived severe complications (controls) caused by these conditions (2005-2013), using data from the UK Obstetric Surveillance System.MethodsMultivariable regression analyses were undertaken to identify the factors that were associated with maternal deaths and to estimate the additive odds associated with the presence of one or more of these factors.Main outcome measuresOdds ratios associated with maternal death and population-attributable fractions, with 95% confidence intervals. Incremental risk of death associated with the factors using a 'risk factors' score.ResultsSix factors were independently associated with maternal death: inadequate use of antenatal care (adjusted odds ratio, aOR 15.87, 95% CI 6.73-37.41); substance misuse (aOR 10.16, 95% CI 1.81-57.04); medical comorbidities (aOR 4.82, 95% CI 3.14-7.40); previous pregnancy problems (aOR 2.21, 95% CI 1.34-3.62); hypertensive disorders of pregnancy (aOR 2.44, 95% CI 1.31-4.52); and Indian ethnicity (aOR 2.70, 95% CI 1.14-6.43). Of the increased risk associated with maternal death, 70% (95% CI 66-73%) could be attributed to these factors. Odds associated with maternal death increased by three and a half times per unit increase in the 'risk factor' score (aOR 3.59, 95% CI 2.83-4.56).ConclusionsThis study shows that medical comorbidities are importantly associated with direct (obstetric) deaths. Further studies are required to understand whether specific aspects of care could be improved to reduce maternal deaths among women with medical comorbidities in the UK.

Dataset Information

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

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusions

Tweetable abstract

Publications

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

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