“Pregnant women and new mothers need closer attention for signs of potentially fatal sepsis, a study says,” reports BBC News.
While still rare, sepsis – a blood infection – is now the leading cause of maternal death in the UK.
Sepsis can potentially be very serious, as it can cause a rapid fall in blood pressure (septic shock), which can lead to multiple organ failure. If untreated, sepsis can be fatal.
The study collected information on all cases of severe sepsis that were treated in hospital maternity units from June 2011 to May 2012.
It found there were 365 confirmed cases of severe sepsis out of over 780,000 maternities. Out of these, five women died (meaning around 0.05% of maternities were affected).
The most common place for the infection to have spread to the blood from was the urinary and genital tract. Severe sepsis occurred rapidly, often within 24 hours of the first symptoms. Over 40% of women with severe sepsis had an illness with a high temperature, or were taking antibiotics in the previous two weeks.
This study highlights the importance of identifying infections in pregnant women and women who have recently given birth, especially in the first few days after delivery. During these periods, if you have a high temperature over 38°C or are on antibiotics but not getting better, you should seek medical attention.
The study was carried out by researchers from the University of Oxford, Northwick Park Hospital, Bradford Royal Infirmary and St Michael’s Hospital in Bristol. It was funded by the National Institute for Health Research.
BBC News reported the study accurately and provided sage advice from one of the authors, Professor Knight, who said that, “women who are pregnant or have recently given birth need to be aware that if they are not getting better after being prescribed antibiotics – for example, if they continue to have high fevers, extreme shivering or pain – they should get further advice from their doctor or midwife urgently”.
This was a case-control study. The researchers studied all women in the UK diagnosed with severe sepsis (blood poisoning) during pregnancy or during the six weeks after delivery in all maternity units in the UK, from June 1 2011 to May 31 2012 (“cases”), as well as two unaffected (“control”) women per case.
Sepsis is the leading cause of maternal death in the UK, with a rate of 1.13 per 100,000 maternities between 2006 and 2008. The aim of this study was to identify risk factors, the sources of infection and type of organisms responsible, in order to improve prevention and management strategies.
A case-control study selects people with a condition, and matches each of them to at least one other person without the condition; this can be done by factors such as age and sex. In this study, controls were women who did not have severe sepsis, and delivered immediately before each case in the same hospital. Medical histories and exposures can then be compared between the cases and controls to look for associations, and thus risk factors, for the condition. This type of study is useful in investigating rare and emergency conditions, but cannot prove causation.
The researchers collected information from all 214 hospitals in the UK that have maternity units led by obstetricians. This included all cases of sepsis around pregnancy and two controls for each case. They compared the sociodemographic, medical history and delivery characteristics between the cases and controls. They also compared the cases that developed into septic shock with those that didn’t, to identify factors that were associated with increased severity.
In terms of severe sepsis cases:
In terms of septic shock cases:
In terms of sources of infection:
In terms of organisms responsible:
Risk factors for severe sepsis included women who:
All types of deliveries requiring operations were risk factors for severe sepsis. These were:
Risk factors for developing septic shock were:
The researchers concluded that “over 40% of women with severe sepsis had a febrile illness or were taking antibiotics prior to presentation, which suggests that at least a proportion were not adequately diagnosed, treated or followed up … it cannot be assumed that antibiotics will prevent progression to severe sepsis … there is a need to ensure that follow-up happens to ensure that treatment is effective”. They also recommend that “signs of severe sepsis in peripartum women, particularly with confirmed or suspected group A streptococcal infection, should be regarded as an obstetric emergency”.
This comprehensive study highlights several areas where awareness of the risks of sepsis in pregnancy should be increased in both primary and secondary care. These include:
Strengths of the study include its size and the 100% participation rate of maternity units in the UK, which should account for any regional or socioeconomic differences.
If you are pregnant or have just given birth, and have signs or symptoms of infection, such as a high temperature of over 38°C, it is important to seek medical advice immediately.