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Physiologic Changes of Pregnancy Commonly Overlap with Systemic Inflammatory Response Syndrome Criteria: A Systematic Review
Abstract Number: MA-02
Abstract Type: Meta Analysis/Review of the Literature
Background: Maternal sepsis is currently the leading cause of direct deaths in the United Kingdom and maternal sepsis-related deaths have doubled in the United States. (1,2) Despite public health implications, the literature lacks evidence-based criteria for Systemic Inflammatory Response Syndrome (SIRS) that specifically adjust for the physiologic changes of gestation and parturition.
Objective: The aim of this study was to conduct a systematic analysis of the normal range values for physiological and laboratory variables in the parturient compared with SIRS criteria.
Methods: PubMed and Embase databases (from 1950 to 2012) were searched to identify observational, randomized controlled trials, case-control, longitudinal, and cross-sectional studies including the following variables during pregnancy: temperature, respiratory rate, PaCO2, heart rate, and white blood cell count. The mean, standard deviation, and two standard deviations from the mean for all criteria parameters published in the literature were reported during the 1st, 2nd, 3rd trimesters, labor, postpartum up to 48 hours, and postpartum four to twelve weeks were compared with SIRS criteria.
Results: Eighty-seven studies were identified with 8,824 patients and 15,323 data points from studies that met inclusion criteria. All mean values for PaCO2 during pregnancy (and up to 48 hours postpartum) were below 32 mmHg. During early and late labor (and up to 48 hours postpartum), the SIRS criterion of white blood cell count of 12 x 10^9/L was within one standard deviation from the mean for non-septic women. SIRS-defining criteria for temperature, respiratory rate, and heart rate were identified between one and two standard deviations above the mean values for normal pregnant and postpartum women. Values outside of the highest two standard deviations from the mean for the remaining criteria were the following: temperature > 38·1°C, respiratory rate > 25 breaths per minute, and heart rate > 107 beats per minute.
Conclusion: Current SIRS criteria often overlap with normal physiology during pregnancy and the immediate postpartum period. This study demonstrates that alternative criteria must be developed to diagnose maternal sepsis.
1)Cantwell R, Clutton-Brock T, Cooper G, 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;118:1-203.
2)Bauer ME, Bateman BT, Bauer ST, et al. Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis. Anesth Analg 2013;117:944-50.