Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study

ObjectiveTo determine the incidence of maternal bacteraemia during pregnancy and for 6weeks postpartum, describe the gestation/stage at which sepsis occurs, the causative microorganisms, antibiotic resistance and review maternal, fetal and neonatal outcome. DesignProspective review. SettingTwo tertiary referral, maternity hospitals in Dublin, Ireland. PopulationDuring 2005-2012 inclusive, 150043 pregnant women attended and 24.4% of infants born in Ireland were delivered at the hospitals. MethodsDemographic, clinical, microbiological and outcome data was collected from women with sepsis and compared with controls. Main outcome measuresIncidence, bacterial aetiology, gestation/stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome. ResultsThe sepsis rate was 1.81 per 1000 pregnant women. Escherichia coli was the predominant pathogen, followed by Group B Streptococcus. Sepsis was more frequent among nulliparous women (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07-1.79) and multiple births (OR 2.04; 95% CI 0.98-4.08). Seventeen percent of sepsis episodes occurred antenatally, 36% intrapartum and 47% postpartum. The source of infection was the genital tract in 61% (95% CI 55.1-66.6) of patients and the urinary tract in 25% (95% CI 20.2-30.5). Sepsis was associated with preterm delivery (OR 2.81; 95% CI 1.99-3.96) and a high perinatal mortality rate (OR=5.78; 95% CI 2.89-11.21). Almost 14% of women required admission to augmented care. The most virulent organisms were Group A Streptococcus linked to postpartum sepsis at term and preterm Escherichia coli sepsis. ConclusionsMaternal sepsis is associated with preterm birth, a high perinatal mortality rate and nulliparous women.