Abstract
SummaryBackgroundMaternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.MethodsWe did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.FindingsBetween Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups.InterpretationThe frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.FundingUNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.
Highlights
Maternal infections are an important cause of maternal mortality and severe maternal morbidity.[1,2]
Global estimates suggest that direct infections are the third most common cause of maternal mortality, representing about 10·7% of maternal deaths,[1] with the largest toll estimated in low-income and middle-income countries (LMICs) at 10·7% compared with highincome countries (HICs) at 4·7%
Of 2965 women assessed for eligibility, 2850 women were included in this analysis who were admitted for or already hospitalised with a suspected or confirmed infection in 713 facilities in 52 countries (408 facilities in 43 LMICs and 305 facilities in nine HICs)
Summary
Maternal infections are an important cause of maternal mortality and severe maternal morbidity.[1,2] Global estimates suggest that direct (obstetric) infections are the third most common cause of maternal mortality, representing about 10·7% of maternal deaths,[1] with the largest toll estimated in low-income and middle-income countries (LMICs) at 10·7% compared with highincome countries (HICs) at 4·7%.1 The contribution of infections to maternal deaths could be larger, as these figures do not include deaths due to abortion-related infections or indirect (non-obstetric) infections, which are not a result of, but aggravated by, pregnancy. The contribution of infections to maternal deaths could be larger, as these figures do not include deaths due to abortion-related infections or indirect (non-obstetric) infections, which are not a result of, but aggravated by, pregnancy. Maternal deaths due to infection occur mainly through maternal sepsis, “a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or post-partum period”.3. This definition aligns with the recent Sepsis-3 definition for adults[4] and includes both direct and indirect infections.[5,6]. Maternal deaths due to infection occur mainly through maternal sepsis, “a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or post-partum period”.3 This definition aligns with the recent Sepsis-3 definition for adults[4] and includes both direct and indirect infections.[5,6]
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