Abstract
BackgroundSepsis was the main cause of maternal mortality in Suriname, a middle-income country. Objective of this study was to perform a qualitative analysis of the clinical and management aspects of sepsis-related maternal deaths with a focus on the ‘golden hour’ principle of antibiotic therapy.MethodsA nationwide reproductive age mortality survey was performed from 2010 to 2014 to identify and audit all maternal deaths in Suriname. All sepsis-related deaths were reviewed by a local expert committee to assess socio-demographic characteristics, clinical aspects and substandard care.ResultsOf all 65 maternal deaths in Suriname 29 (45%) were sepsis-related. These women were mostly of low socio-economic class (n = 23, 82%), of Maroon ethnicity (n = 14, 48%) and most deaths occurred postpartum (n = 21, 72%). Underlying causes were pneumonia (n = 14, 48%), wound infections (n = 3, 10%) and endometritis (n = 3, 10%). Bacterial growth was detected in 10 (50%) of the 20 available blood cultures. None of the women with sepsis as underlying cause of death received antibiotic treatment within the first hour, although most women fulfilled the diagnostic criteria of sepsis upon admission. In 27 (93%) of the 29 women from which sufficient information was available, substandard care factors were identified: delay in monitoring in 16 (59%) women, in diagnosis in 17 (63%) and in treatment in 21 (78%).ConclusionIn Suriname, a middle-income country, maternal mortality could be reduced by improving early recognition and timely diagnosis of sepsis, vital signs monitoring and immediate antibiotic infusion (within the golden hour).
Highlights
Sepsis is a major cause of severe maternal morbidity and mortality, especially in low- and middleincome countries
None of the women with sepsis as underlying cause of death received antibiotic treatment within the first hour, most women fulfilled the diagnostic criteria of sepsis upon admission
Three major findings of our study were identified: first, most sepsis-related maternal deaths occurred in women with low economic status and postpartum, within one week after delivery; second, the most common identified source of sepsis causing maternal deaths in Suriname was pneumonia; and there was a major delay in monitoring, diagnosis and prompt treatment with regards to the golden hour principle
Summary
Sepsis is a major cause of severe maternal morbidity and mortality, especially in low- and middleincome countries. Recognition of sepsis during pregnancy, delivery and postpartum is difficult because of physiological adaptations to pregnancy, blood loss and increased maternal activity during labour [3]. WHO recently launched a new consensus defining maternal sepsis: a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or postpartum period [4]. Sepsis was the main cause of maternal mortality in Suriname, a middle-income country. Objective of this study was to perform a qualitative analysis of the clinical and management aspects of sepsis-related maternal deaths with a focus on the ‘golden hour’ principle of antibiotic therapy
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