Perinatal outcomes among patients with sepsis during pregnancy

1. Pregnancies with antepartum sepsis were associated with placental dysfunctions

2. Increased antenatal surveillance to avoid sepsis during pregnancy may reduce the risk of fetal complications

Evidence Rating Level: 2 (Good)

Maternal sepsis is a prevalent, life threatening condition that evolves rapidly with a fatality rate ranging from 10% to 30% in the United States. Sepsis during pregnancy is often associated with preterm deliveries as well as emergencies such as postpartum hemorrhage. The majority of studies focus on peripartum infection and emergent situations during labour or postpartum intensive care admissions. However, fewer studies have investigated the association between sepsis and long term outcomes in maternal and fetal health. This study aimed to address this gap by examining placental complications among patients who experienced antepartum sepsis hospitalizations and subsequently recovered from their infections. This retrospective cohort study of 14565 patients collected data between 2012-2018 on patients with uncomplicated, singleton pregnancies after 20 weeks’ gestation. Patients were assessed for antenatal sepsis between the first confirmation of pregnancy until the onset of labour.  Perinatal outcomes were also analyzed for placental dysfunctions including fetal growth restriction leading to small for gestational age, stillbirth, preeclampsia, and deficient amniotic fluid levels.  These outcomes were compared between the sepsis group and the reference group. Overall, of the 14565 patients, n= 59 had antenatal sepsis with the most common causes coming from urinary tract and pulmonary infections.  Individuals who had experienced antepartum sepsis hospitalisations had twice the risk of placental dysfunctions (n=21 [35.6%] vs n=3450 [23.8%]; odds ratio, 1.77; 95% CI, 1.04-3.02). Furthermore, sepsis patients were at higher risk of postpartum hemorrhage, maternal ICU admissions, and preeclampsia compared to their non septic counterparts.  As previously mentioned, prior studies have focused primarily on immediate maternal morbidity and mortality. Therefore, a strength of this study was its focus on obstetric and postpartum health as well as neon ration outcomes. On the other hand, a limitation of this study was its lack of analysis for the severity of sepsis. Some patients may have experienced life threatening sepsis while others may have had an acute and rapidly treated infection. Overall, this study is very clinically relevant as it highlights the importance of increasing antenatal surveillance and monitoring for sepsis to avoid placental dysfunction. History of antepartum sepsis significantly increased obstetric complications and postpartum health and therefore should be monitored carefully.

Click to read the study in JAMA Network Open

Image: PD

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