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Retrospective study examining patient characteristics of women diagnosed with maternal sepsis, severe sepsis and septic shock
Abstract Number: T-66
Abstract Type: Original Research
Introduction: Sepsis is a leading cause of maternal death in the US and the UK (1, 2). However, there has been limited examination of maternal characteristics of women diagnosed with sepsis, severe sepsis and septic shock. Our primary aim was to describe patient characteristics and microbiological findings of hospitalized women diagnosed with maternal sepsis, severe sepsis or septic shock in a single tertiary obstetric center.
Methods and Materials: After gaining IRB approval we identified women with ICD-9 codes for sepsis, severe sepsis and septic shock who were admitted to a single tertiary obstetric center over a 7-year period (2007–2013). The diagnosis of sepsis, severe sepsis and septic shock was confirmed using criteria defined at the International Sepsis Definitions Conference (ISDC) (3). Based on medical chart review we abstracted demographic, obstetric and pathological data for women who met ISDC criteria for a clinical diagnosis of sepsis, severe sepsis or septic shock. Data are presented as number (%), mean (SD) and median [IQR].
Results: After reviewing medical records of women with ICD-9 codes for septic morbidities, 35 women met criteria for sepsis, severe sepsis or septic shock. Over the study period, the rates of sepsis, severe sepsis and septic shock were 69, 19 and 22 per 100,000 deliveries respectively. Demographic, obstetric and microbiological data are presented in Table 1. The majority of women presented with a septic diagnosis after cesarean delivery, with the genital tract identified as the most common infection source. A pre-existing medical illness or obstetric disease was common among women with a septic diagnosis. Fifty percent of women with sepsis and severe sepsis had negative microbiological cultures.
Discussion: In our study, the genital tract was the most common site of infection, which is consistent with national and international data (2). However, many patients with sepsis and severe sepsis did not have a confirmed infectious agent. Data from this study suggest that the prevalence of sepsis may be highest among postpartum women who deliver by cesarean with a medical and/or obstetric comorbidity. Surveillance studies are needed to confirm these findings and to identify risk factors for maternal sepsis before and after delivery.
2) Obstet Gynecol 2015;125:5–12
3) Crit Care Med 2003;31:1250-1256