Maternal sepsis: a Scottish population-based case-control study

C D Acosta, S Bhattacharya, D Tuffnell, J J Kurinczuk, M Knight, C D Acosta, S Bhattacharya, D Tuffnell, J J Kurinczuk, M Knight

Abstract

Objective: To describe the risk of maternal sepsis associated with obesity and other understudied risk factors such as operative vaginal delivery.

Design: Population-based, case-control study.

Setting: North NHS region of Scotland.

Population: All cases of pregnant, intrapartum and postpartum women with International Classification of Disease-9 codes for sepsis or severe sepsis recorded in the Aberdeen Maternal and Neonatal Databank (AMND) from 1986 to 2009. Four controls per case selected from the AMND were frequency matched on year-of-delivery.

Methods: Cases and controls were compared; significant variables from univariable regression were adjusted in a multivariable logistic regression model.

Main outcome measures: Dependent variables were uncomplicated sepsis or severe ('near-miss') sepsis. Independent variables were demographic, medical and clinical delivery characteristics. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) are reported.

Results: Controlling for mode of delivery and demographic and clinical factors, obese women had twice the odds of uncomplicated sepsis (OR 2.12; 95% CI 1.14-3.89) compared with women of normal weight. Age <25 years (OR 5.15; 95% CI 2.43-10.90) and operative vaginal delivery (OR 2.20; 95% CI 1.02-4.87) were also significant predictors of sepsis. Known risk factors for maternal sepsis were also significant in this study (OR for uncomplicated and severe sepsis respectively): multiparity (OR 6.29, 12.04), anaemia (OR 3.43, 18.49), labour induction (OR 3.92 severe only), caesarean section (OR 3.23, 13.35), and preterm birth (OR 2.46 uncomplicated only).

Conclusions: Obesity, operative vaginal delivery and age <25 years are significant risk factors for sepsis and should be considered in clinical obstetric care.

© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Figures

Figure 1
Figure 1
Incidence of all sepsis and severe sepsis cases per 1,000 maternities from 1986-2009 in Aberdeen (three-year rolling averages).

References

    1. 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 1992. Chest. 2009;136(Suppl 5):e28.
    1. Paruk F. Infection in obstetric critical care. Best Pract Res Clin Obstet Gynaecol. 2008;22:865–83.
    1. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011;118(Suppl 1):1–203.
    1. Schuitemaker N, van Roosmalen J, Dekker G, van Dongen P, van Geijn H, Bennebroek Gravenhorst J. Confidential enquiry into maternal deaths in The Netherlands 1983–1992. Eur J Obstet Gynecol Reprod Biol. 1998;79:57–62.
    1. Zwart JJ, Dupuis JR, Richters A, Ory F, van Roosmalen J. Obstetric intensive care unit admission: a 2-year nationwide population-based cohort study. Intensive Care Med. 2010;36:256–63.
    1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.
    1. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35:1244–50.
    1. Sakorafas GH, Tsiotou AG. Current Pathogenic Concepts, Optimal Management, and Future Perspectives. New York: Nova Science Publishers Inc; 2005.
    1. Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Facing the challenge: decreasing case fatality rates in severe sepsis despite increasing hospitalizations. Crit Care Med. 2005;33:2555–62.
    1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–10.
    1. Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34:344–53.
    1. Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K. Epidemiology of severe sepsis occurring in the first 24 hours in intensive care units in England, Wales, and Northern Ireland. Crit Care Med. 2003;31:2332–8.
    1. Pattinson RC, Hall M. Near misses: a useful adjunct to maternal death enquiries. Br Med Bull. 2003;67:231–43.
    1. Fitzpatrick C, Halligan A, McKenna P, Coughlan BM, Darling MR, Phelan D. Near miss maternal mortality (NMM) Ir Med J. 1992;85:37.
    1. Smaill F. Antibiotic prophylaxis and caesarean section. Br J Obstet Gynaecol. 1992;99:789–90.
    1. Yokoe DS, Christiansen CL, Johnson R, Sands KE, Livingston J, Shtatland ES, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis. 2001;7:837–41.
    1. Maharaj D. Puerperal pyrexia: a review. Part I. Obstet Gynecol Surv. 2007;62:393–9.
    1. Kramer HM, Schutte JM, Zwart JJ, Schuitemaker NW, Steegers EA, van Roosmalen J. Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta Obstet Gynecol Scand. 2009;88:647–53.
    1. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010;23:249–54.
    1. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25:1175–82.
    1. Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112:768–72.
    1. Robinson HE, O'Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol. 2005;106:1357–64.
    1. Martens MG, Kolrud BL, Faro S, Maccato M, Hammill H. Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases. J Reprod Med. 1995;40:171–5.
    1. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Aust N Z J Obstet Gynaecol. 1994;34:398–402.
    1. Department of Health. 2008. Health survey for England 2007 latest trends [NS]
    1. Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol. 2010;115:989–97.
    1. Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG. 2007;114:187–94.
    1. Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG. 2005;112:1431–3.
    1. Lewis G, editor. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: CEMACH; 2007. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer – 2003–2005; pp. 1–265.
    1. Bhattacharya S, Townend J. Recurrent miscarriage: are three miscarriages one too many? Analysis of a Scottish population-based database of 151,021 pregnancies. Eur J Obstet Gynecol Reprod Biol. 2010;150:24–7.
    1. Humphrey T, Tucker JS. Rising rates of obstetric interventions: exploring the determinants of induction of labour. J Public Health (Oxf) 2009;31:88–94.
    1. Bhattacharya S, Campbell DM. The incidence of severe complications of preeclampsiaHypertens Pregnancy. 2005;24:181–90.
    1. Briese V, Voigt M, Wisser J, Borchardt U, Straube S. Risks of pregnancy and birth in obese primiparous women: an analysis of German perinatal statistics. Arch Gynecol Obstet. 2011;283:249–53.
    1. Lamagni TL, Efstratiou A, VuopioVarkila J, Jasir A, Schalén C StrepEURO. The epidemiology of severe Streptococcus pyogenes associated disease in Europe. Euro Surveill. 2005;10:179–84.
    1. Health Protection Agency. 2009. Group A streptococcal infections: 2008/2009 update on seasonal activity. Health Protection Report [Serial Online] 3(2)
    1. Lamagni TL, Efstratiou A, Dennis J, Nair P, Kearney J, George R, et al. Increase in invasive group A streptococcal infections in England, Wales and Northern Ireland, 2008/09. Euro Surveill. 2009;14 pii:19110.
    1. Loudon I. The Tragedy of Childbed Fever. Oxford: Oxford University Press; 2000.
    1. National Institute for Health Clinical Excellence (NICE) caesarean Section; Clinical guidelines CG13. London: National Institute for Health; 2004.
    1. Johnson SR, Kolberg BH, Varner MW, Railsback LD. Maternal obesity and pregnancy. Surg Gynecol Obstet. 1987;164:431–7.
    1. Murphy DJ, Liebling RE, Verity L, Swingler R, Patel R. Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study. Lancet. 2001;358(9289):1203–7.
    1. Girard F, Burlet G, Bayoumeu F, Fresson J, Bouvier-Colle MH, Boutroy JL. [Severe complications of pregnancy and delivery: the situation in Lorraine based on the European investigation] J Gynecol Obstet Biol Reprod (Paris) 2001;30(Suppl 6):S10–7.
    1. Liu S, Heaman M, Joseph KS, Liston RM, Huang L, Sauve R, et al. Risk of maternal postpartum readmission associated with mode of delivery. Obstet Gynecol. 2005;105:836–42.
    1. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. JAMA. 2000;283:2411–6.
    1. Waterstone M, Bewley S, Wolfe C. Incidence and predictors of severe obstetric morbidity: case–control study. BMJ. 2001;322:1089–93. Discussion 93–4.
    1. Yamada T, Yamamura MK, Katabami K, Hayakawa M, Tomaru U, Shimada S, et al. Invasive group A streptococcal infection in pregnancy. J Infect. 2010;60:417–24.
    1. The Information Center CHS. NHS Maternity Statistics, England: 2004–05. London: The Information Center; 2006.
    1. ACOG Committee on Practice Bulletins – Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol. 2009;114:386–97.
    1. National Institute for Health Clinical Excellence (NICE) CG70 Induction of labour. London: NICE; 2008.
    1. Modder J, Fitzsimons K. Management of Women with Obesity in Pregnancy. Centre for Maternal and Child Enquiries and the Royal College of Obstetricians and Gynaecologists; 2010.

Source: PubMed

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