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Medline ® Abstract for Reference 41

of 'Critical illness during pregnancy and the peripartum period'

Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study.
Knowles SJ, O'Sullivan NP, Meenan AM, Hanniffy R, Robson M
BJOG. 2015 Apr;122(5):663-71. Epub 2014 May 23.
OBJECTIVE: To determine the incidence of maternal bacteraemia during pregnancy and for 6 weeks postpartum, describe the gestation/stage at which sepsis occurs, the causative microorganisms, antibiotic resistance and review maternal, fetal and neonatal outcome.
DESIGN: Prospective review.
SETTING: Two tertiary referral, maternity hospitals in Dublin, Ireland.
POPULATION: During 2005-2012 inclusive, 150 043 pregnant women attended and 24.4% of infants born in Ireland were delivered at the hospitals.
METHODS: Demographic, clinical, microbiological and outcome data was collected from women with sepsis and compared with controls.
MAIN OUTCOME MEASURES: Incidence, bacterial aetiology, gestation/stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome.
RESULTS: The sepsis rate was 1.81 per 1000 pregnant women. Escherichia coli was the predominant pathogen, followed by Group B Streptococcus. Sepsis was more frequent among nulliparous women (odds ratio [OR]1.39; 95% confidence interval [CI]1.07-1.79) and multiple births (OR 2.04; 95% CI 0.98-4.08). Seventeen percent of sepsis episodes occurred antenatally, 36% intrapartum and 47% postpartum. The source of infection was the genital tract in 61% (95% CI 55.1-66.6) of patients and the urinary tract in 25% (95% CI 20.2-30.5). Sepsis was associated with preterm delivery (OR 2.81; 95% CI 1.99-3.96) and a high perinatal mortality rate (OR =5.78; 95% CI 2.89-11.21). Almost 14% of women required admission to augmented care. The most virulent organisms were Group A Streptococcus linked to postpartum sepsis at term and preterm Escherichia coli sepsis.
CONCLUSIONS: Maternal sepsis is associated with preterm birth, a high perinatal mortality rate and nulliparous women.
Department of Microbiology, National Maternity Hospital, Dublin, Ireland.