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Maternal morbidity and mortality from severe sepsis: a national cohort study
  1. Colleen D Acosta1,
  2. David A Harrison2,
  3. Kathy Rowan2,
  4. D Nuala Lucas3,
  5. Jennifer J Kurinczuk1,
  6. Marian Knight1
  1. 1National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Intensive Care National Audit & Research Centre (ICNARC), London, UK
  3. 3Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex, UK
  1. Correspondence to Professor Marian Knight; marian.knight{at}npeu.ox.ac.uk

Abstract

Objectives To describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK.

Design National cohort study.

Setting 198 critical care units in the UK.

Participants 646 pregnant and recently pregnant women who had severe sepsis within the first 24 hours of admission in 2008–2010.

Primary and secondary outcome measures Septic shock, mortality.

Results Of all maternal critical care admissions, 14.4% (n=646) had severe sepsis; 10.6% (n=474) had septic shock. The absolute risk of maternal critical care admission with severe sepsis was 4.1/10 000 maternities. Pneumonia/respiratory infection (irrespective of the H1N1 pandemic influenza strain) and genital tract infection were the most common sources of sepsis (40% and 24%, respectively). We identified a significant gradient in the risk of severe maternal sepsis associated with increasing deprivation (RR=6.5; 95% CI 4.9 to 8.5 most deprived compared with most affluent women). The absolute risk of mortality was 1.8/100 000 maternities. The most common source of infection among women who died was pneumonia/respiratory infection (41%). Known risk factors for morbidity supported by this study were: younger age, multiple gestation birth and caesarean section. Significant risk factors for mortality in unadjusted analysis were: age ≥35 years (unadjusted OR (uOR)=3.5; 95% CI 1.1 to 10.6), ≥3 organ system dysfunctions (uOR=12.7; 95% CI 2.9 to 55.1), respiratory dysfunction (uOR=6.5; 95% CI1.9 to 21.6), renal dysfunction (uOR=5.6; 95% CI 2.3 to 13.4) and haematological dysfunction (uOR=6.5; 95% CI 2.9 to 14.6).

Conclusions This study suggests a need to improve timely recognition of severe respiratory tract and genital tract infection in the obstetric population. The social gradient associated with the risk of severe sepsis morbidity and mortality raises important questions regarding maternal health service provision and usage.

  • sepsis
  • pregnancy
  • critical care
  • cohort study

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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