Study Finds Increase in Maternal Sepsis-Related Mortality

A study presented at the ANESTHESIOLOGY 2012 annual meeting reports that severity and death rates are increasing in pregnant and postpartum women with sepsis. More than 30 percent of mothers who develop sepsis will experience some type of organ dysfunction.

There is little known about sepsis in the United States, which is defined as a severe infection causing an inflammatory response in the body leading to possible organ system dysfunction and even death in pregnant and postpartum patients.

In the United Kingdom, maternal deaths related to sepsis are increasing, and it is currently one of the leading causes of death in pregnant women or postpartum women. In the U.S., it is unknown how many women are affected by this disease.

The importance of this research is that it helps define the problem of sepsis during pregnancy, says Melissa E. Bauer, DO, of the University of Michigan Department of Anesthesiology. The more we know about this disease, the more we will be able to do to help prevent, diagnose and treat it.

To determine the incidence, severity of the disease in those affected, quantify how many deaths are related to sepsis, and determine risk factors for sepsis, the study used a database representing 44 million patients over 11 years.

The results revealed:

The incidence of sepsis is approximately 1:3,300 during hospitalization for childbirth.
An estimated 1:10,000 deliveries will be complicated by sepsis, leading to organ system dysfunction.
About 1 in 100,000 will die from sepsis during hospitalization for childbirth.

Identifying risk factors for sepsis is an important process to help guide physicians to more closely monitor those at an elevated risk. Certain conditions may be associated with an elevated risk for sepsis, including medical conditions such as chronic congestive heart failure, chronic liver disease, chronic kidney disease, lupus and HIV. All women, especially women with these conditions, should be educated about the signs of infection and precautions to take to avoid infection.

Pregnant patients are at a higher risk for infection than the general population, adds Bauer. The most common infections that may be causing these severe infections are urinary tract infections, pneumonia and chorioamnionitis (infection of the membranes and amniotic fluid). As infection worsens, it could lead to sepsis.

Precautions should be taken to avoid any infection, such as washing hands frequently, avoiding sick contacts and reporting any illness immediately. Clinical signs of sepsis include: low temperature, fever, rapid heart rate, low blood pressure, rapid breathing rate, low oxygen level, changes in mental status and decreased urine output. Any patient with symptoms of this type or overall malaise should seek help from her healthcare provider.

Identifying the incidence and understanding the key risk factors for maternal sepsis will increase health care providers and the general publics knowledge, encourage education and promote increased surveillance surrounding this important public health issue, Bauer adds.

Source: American Society of Anesthesiologists (ASA)