Abstract
BackgroundThere is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis.MethodsAll original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego.ResultsStandardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition “Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period”. Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population.ConclusionThe operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of care (administration of antimicrobials and fluids, support of vital organ functions, and referral) and improve maternal outcomes.
Highlights
Sepsis is a major public health concern [1]
The literature review and expert consultation resulted in a new World Health Organization (WHO) consensus definition
Plans are in progress to validate the new WHO definition of maternal sepsis and identification criteria in a large international population
Summary
Sepsis includes three essential components: infection, host response to infection and organ dysfunction. Pregnant women are predisposed to develop infections and sepsis for several reasons. Physiological adaptations to pregnancy (e.g. hyperdynamic circulation, tachycardia, diminished oxygen reserve, hypercoagulability), maternal efforts during second stage of labour, interventions during labour, or blood loss, may obscure signs and symptoms of infection and sepsis [3, 4]. This may result in delays in the recognition and treatment of sepsis [5]. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis
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