Abstract
BackgroundThe Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.MethodsA case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC).ResultsMultivariable analysis revealed that 1–4 antenatal visits (95% CI 0.01–0.62)., 3 or more vaginal examinations (95% CI 1.21–3.65), home delivery (95% CI 1.72–50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93–20.23), lower abdominal pain (95% CI 1.15–3.42)) vaginal discharge (95% CI 2.97–20.21), SpO2 < 93% (95% CI 4.80–37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80–0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis.ConclusionThis study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.
Highlights
The Majority (99%) of maternal deaths occur in low and middle-income countries
810 women globally die every day from preventable causes related to pregnancy and childbirth and almost one-third of these occur in South Asia [1]
Preterm delivery was present in 20% of women with sepsis as compared to 11% in controls
Summary
The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). These criteria require laboratory investigations that may not be feasible in resource-constrained settings. Pregnancy and childbirth-related complications are a major public health concern worldwide. 810 women globally die every day from preventable causes related to pregnancy and childbirth and almost one-third of these occur in South Asia [1]. Pakistan Demographic Health Survey (PDHS 2006) reported sepsis as a third major cause of maternal mortality which contributes to 14% of maternal deaths in Pakistan [4, 5]. Increasing severity of infection correlates with increased mortality, which is 16.7% for sepsis, 25–30% for severe sepsis and up to 40–70% for septic shock [7, 8] in the general population
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