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Maternal Sepsis: Recognition, Treatment, and Escalation of Care

  • Obstetric Anesthesia (LR Leffert, Section Editor)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

An Author Correction to this article was published on 16 January 2020

This article has been updated

Abstract

Purpose of Review

The purpose of this article is to provide a brief review of maternal sepsis and the supporting literature for recognition and management.

Recent Findings

Recent findings suggest that there is significant room for improvement in identifying patients at risk, expeditiously providing appropriate intervention, and developing action plans to best care for these patients and prevent morbidity and mortality.

Summary

Improved education and understanding of the unique presentation of sepsis during pregnancy may help to improve detection, timely treatment, and expedite appropriate transfer to higher levels of care.

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Change history

  • 16 January 2020

    The original version of this article contained two mistakes. In Table 2, under the ���MEW criteria��� heading, ���DBP < 100 mmHg��� should read ���DBP > 100 mmHg.��� The correct Table 2 is shown here.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol. 2017;130(2):366–73.

    Article  Google Scholar 

  2. • Bonet M, Nogueira Pileggi V, Rijken MJ, Coomarasamy A, Lissauer D, Souza JP, et al. Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation. Reprod Health. 2017;14(1):67 This article reports the World Health Organization consensus definition of maternal sepsis.

    Article  Google Scholar 

  3. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10.

    Article  CAS  Google Scholar 

  4. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.

    Article  CAS  Google Scholar 

  5. Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M. Maternal sepsis: a Scottish population-based case-control study. BJOG. 2012;119(4):474–83.

    Article  CAS  Google Scholar 

  6. • Acosta CD, Knight M, Lee HC, Kurinczuk JJ, Gould JB, Lyndon A. The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study. PLoS One. 2013;8(7):e67175 This is a population-based study describing the incidence and identifying risk factors for maternal sepsis.

    Article  CAS  Google Scholar 

  7. • Acosta CD, Kurinczuk JJ, Lucas DN, Tuffnell DJ, Sellers S, Knight M. Severe maternal sepsis in the UK, 2011–2012: a national case-control study. PLoS Med. 2014;11(7):e1001672 This is a UK case-control study that describes the incidence, identifies risk factors, and describes the most common sources and organisms associated with maternal sepsis.

    Article  Google Scholar 

  8. • Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg. 2013;117(4):944–50 This is a US-population based study to determine incidence, temporal trends, and associations for maternal sepsis.

    Article  Google Scholar 

  9. Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858–73.

    Article  Google Scholar 

  10. •• Bauer ME, Housey M, Bauer ST, Behrmann S, Chau A, Clancy C, et al. Risk factors, etiologies, and screening tools for sepsis in pregnant women: a multicenter case-control study. Anesth Analg. 2018; This is a case-control study evaluating the performance of the SIRS, qSOFA, and MEW criteria for identifying maternal sepsis as well as identifying risk factors and etiologies of maternal sepsis.

  11. •• Bauer ME, Lorenz RP, Bauer ST, Rao K, Anderson FW. Maternal deaths due to sepsis in the state of Michigan, 1999-2006. Obstet Gynecol. 2015;126(4):747–52 This is a case series reviewing the state of Michigan pregnancy-related deaths from sepsis and identifying areas for improvement in management.

    Article  Google Scholar 

  12. Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths: results of a state-wide review. Obstet Gynecol. 2005;106(6):1228–34.

    Article  Google Scholar 

  13. Knight M, Nair M, Tuffnell D, Shakespeare J, Kenyon S, Kurinczuk JJ, et al. Saving lives, improving mothers’ care - lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2013–15. Oxford: National Perinatal Epidemiology Unit: University of Oxford; 2017.

    Google Scholar 

  14. Axelsson D, Blomberg M. Maternal obesity, obstetric interventions and post-partum anaemia increase the risk of post-partum sepsis: a population-based cohort study based on Swedish medical health registers. Infect Dis (Lond Engl). 2017;49(10):765–71.

    Article  Google Scholar 

  15. Snyder CC, Barton JR, Habli M, Sibai BM. Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes. J Matern Fetal Neonatal Med. 2013;26(5):503–6.

    Article  CAS  Google Scholar 

  16. Serafim R, Gomes JA, Salluh J, Povoa P. A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of Sepsis and prediction of mortality: a systematic review and meta-analysis. Chest. 2018;153(3):646–55.

    Article  Google Scholar 

  17. • Albright CM, Has P, Rouse DJ, Hughes BL. Internal validation of the sepsis in obstetrics score to identify risk of morbidity from sepsis in pregnancy. Obstet Gynecol. 2017;130(4):747–55 This prospective study validated the pregnancy-specific sepsis in obstetrics score to identify patients at risk of ICU admission for sepsis.

    Article  Google Scholar 

  18. Bauer ME, Bauer ST, Rajala B, MacEachern MP, Polley LS, Childers D, et al. Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis. Obstet Gynecol. 2014;124(3):535–41.

    Article  CAS  Google Scholar 

  19. •• Mhyre JM, D'Oria R, Hameed AB, Lappen JR, Holley SL, Hunter SK, et al. The maternal early warning criteria: a proposal from the national partnership for maternal safety. Obstet Gynecol. 2014;124(4):782–6 This article reviews the evidence for objective systems to identify mothers at risk for sepsis and describes the Maternal Early Warning Criteria.

    Article  Google Scholar 

  20. •• Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552 These are the consensus guidelines from the most recent Surviving Sepsis Campaign for the management of sepsis and septic shock.

    Article  Google Scholar 

  21. Barton JR, Sibai BM. Severe sepsis and septic shock in pregnancy. Obstet Gynecol. 2012;120(3):689–706.

    Article  Google Scholar 

  22. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.

    Article  Google Scholar 

  23. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J. 1999;18(12):1096–100.

    Article  CAS  Google Scholar 

  24. Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642–7.

    Article  Google Scholar 

  25. Lu N, Xi X, Jiang L, Yang D, Yin K. Exploring the best predictors of fluid responsiveness in patients with septic shock. Am J Emerg Med. 2017;35(9):1258–61.

    Article  Google Scholar 

  26. Bauer ME, Balistreri M, MacEachern M, Cassidy R, Schoenfeld R, Sankar K, et al. Normal range for maternal lactic acid during pregnancy and labor: a systematic review and meta-analysis of observational studies. Am J Perinatol. 2018.

  27. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice bulletin no. 170: critical care in pregnancy. Obstet Gynecol 2016;128(4):e147–54.

  28. Calculation of sepsis in obstetrics score: focus information technology; 2015-2016. Available from: http://perinatology.com/calculators/Sepsis%20Calculator.htm. Accessed 13 Jan 2019

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Correspondence to Melissa E. Bauer.

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Emily E. Naoum and Melissa E. Bauer declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Obstetric Anesthesia

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Naoum, E.E., Bauer, M.E. Maternal Sepsis: Recognition, Treatment, and Escalation of Care. Curr Anesthesiol Rep 9, 55–59 (2019). https://doi.org/10.1007/s40140-019-00310-7

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  • DOI: https://doi.org/10.1007/s40140-019-00310-7

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