Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis

Summary

Key points

• Maternal sepsis, including respiratory, urinary and other infections as well as genital tract sepsis, remains of concern internationally. However, few studies have investigated the factors association with progression from severe sepsis to death.
• The aim of this study was to use data from UKOSS and the MBRRACE-UK Confidential Enquiry into Maternal Death to identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK.
• 43 women who died from non-influenza related maternal sepsis between January 2009 and December 2012 were compared with 358 women who survived severe non-influenza sepsis in pregnancy between June 2011 and May 2012.
• Only 14 (33%) of the women who died received antibiotics within the ‘golden hour’.
• Women who died were more likely to have never received antibiotics (aOR = 22.7, 95% CI 3.64–141.6), to have medical comorbidities (aOR = 2.53, 95%CI 1.23–5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62–7.89).
• Anaemia (aOR = 13.5, 95%CI 3.17–57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93–116.9) were the two most important factors driving the association between medical comorbidities and progression to death.
• This study emphasises further the importance of continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis-related maternal deaths.