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Maternal Sepsis Deaths in the State of Michigan 1999 - 2006
Abstract Number: T-51
Abstract Type: Original Research
Introduction: Deaths due to maternal sepsis increased in the United States from 1998 to 2008.(1) According to the UK Saving Mothers’ Lives report for the epoch 2009-2012, almost 25% of all maternal deaths were due to sepsis.(2) Diagnosis remains challenging due to the physiologic changes of pregnancy, resulting in delays of diagnosis and treatment.(3) The aim of this case series is to identify maternal sepsis deaths, review the events leading to diagnosis, and evaluate treatment to identify areas for improvement.
Methods: All maternal deaths in the state of Michigan 1999-2006 during pregnancy and up to 42 days postpartum were identified with Maternal Mortality Surveillance records from the Michigan Department of Community Health. Cause of death was determined from death certificates or by consensus of the Maternal Mortality Medical Surveillance Committee. Records were reviewed by both an obstetrician and an obstetric anesthesiologist.
Results: Maternal sepsis was the cause of direct death in 3.7% (22/593) of all maternal deaths during the time period. Of 22 maternal sepsis deaths, 12 women presented to the hospital with sepsis, three developed sepsis during hospitalization, and seven died at home. Of the women presenting to the hospital with sepsis, 75.0% (9/12) demonstrated one or more of the following vital sign derangements: HR>120, RR>30, SBP<90 mmHg, SpO2 <95% on room air (Maternal Early Warning Criteria).(4) Only 16.7% (2/12) of septic women were febrile on presentation, and many remained afebrile with resultant delays of diagnosis. One or more recognized risk factors for severe sepsis including: cesarean delivery, retained products of conception, stillbirth, and tobacco use were present in 77.3% (17/22) of all sepsis deaths. The most common organism was Group A Strep in 28.6% (4/14) of women with an identified organism. Delays of care occurred in the majority of deaths including 31.8% (7/22) of women who died at home.
Conclusions: In the majority of maternal sepsis deaths over eight years in the state of Michigan, there were delays in recognition of sepsis and escalation of care despite vital sign derangement. Escalation of care should include more frequent vital sign monitoring, adequate resuscitation, and prompt broad-spectrum antibiotic administration. Fever was rarely present in women who died of sepsis, and is not required for diagnosis. Educating patients about when to seek medical treatment may help decrease the rate of deaths occurring at home. Implementation of Maternal Early Warning Criteria may provide heightened awareness of changes in vital signs to aid in earlier diagnosis.
1) Bauer ME, et al. Anesth Analg 2013;117:944-50.
2) Knight M, et al. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2014.
3) Bauer ME, et al. Obstet Gynecol 2014;124:535-41.
4) Mhyre, JM et al. Obstet Gynecol 2014;124:782-6.