WASHINGTON – Sepsis among women giving birth appears to be growing deadlier, researchers said here.
The incidence of sepsis remained stable over an 11-year period in the U.S., but the risk of death from the condition rose from 0.7 to 1.6 per 100,000 deliveries between 1998 and 2008 (P<0.001), Melissa Bauer, DO, of the University of Michigan at Ann Arbor, and colleagues reported at the American Society of Anesthesiologists meeting.
Patients at risk of worse outcomes with sepsis were those with comorbid conditions such as congestive heart failure, liver disease, and lupus, Bauer told MedPage Today.
She explained that the U.K. keeps close tabs on sepsis rates in labor and delivery wards, and their data have shown an increase in maternal deaths from sepsis in recent years, rising from 0.65 per 100,000 deliveries in 2000-2002, to 1.13 per 100,000 in 2006-2008.
In the U.S., however, there are few data on the epidemiology of sepsis in pregnancy, with incidence estimates largely based on retrospective reviews from tertiary care centers, Bauer said.
So Bauer and colleagues looked at data from the Nationwide Inpatient Sample (NIS) between 1998 and 2008, with information on more than 9 million admissions for delivery. The sample was weighted to give nationwide estimates of 44 million patients, she said.
They found that overall, sepsis occurred in one out of every 3,334 deliveries, and severe sepsis complicated one in every 10,8222 deliveries, meaning the sepsis was severe in 30.8% of cases.
Sepsis-related death occurred in one in 104,893 deliveries, or 3.2% of sepsis cases, Bauer and colleagues found.
While the overall incidence of sepsis was stable across the study period, Bauer said, the risk of sepsis-related death rose from 0.7 to 1.6 per 100,000 deliveries (P<0.001).
Bauer noted that the reasons for the rise remain unclear, and that further study is needed to look deeper into the issue.
She did, however, note that some patients appear to be at greater risk for severe sepsis. That includes patients with congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematosus, or HIV, as well as those whose deliveries involved use of cervical cerclage.
The researchers also found that the most common concurrent infectious diagnoses in severe sepsis were genitourinary tract infection (22.4%), pneumonia (22.2%), and chorioamnionitis (14.2%), and the most common types of organ dysfunction were respiratory dysfunction (54.4%), coagulation abnormalities (30.2%), and renal dysfunction (25.9%).
Bauer urged that clinicians look for sepsis risk factors in their labor and delivery wards, and women who are at risk for sepsis-related death should be educated about the signs of infection.
She said her facility is set to implement criteria similar to those launched in Britain in 2007 after that country detected increases in sepsis rates. Those criteria, obstetric MEWS (modified early warning system), were designed to aid in the early recognition of acutely ill patients.
“Although there is no hard evidence at this time that this may improve outcomes, it is a helpful tool to provide an objective threshold for the nurse to notify a physician based on a deviation of physiological parameters,” Bauer told MedPage Today.
“Even if you can’t implement MEWS in the entire hospital,” she added, “at least do it in at-risk patients.”
Martin Doerfler, MD, of North Shore-Long Island Jewish Health System, told MedPage Todaythat the proportion of sepsis, and especially deaths related to sepsis, is still exceedingly low.
“Small changes in small numbers look like very large changes proportionally,” Doerfler said in an email. “Death in 3.2% of sepsis cases is low compared to death from all sepsis cases.”
Still, he said, the “death of a new mother is always tragic,” while sepsis deaths in elderly or frail patients may be more expected.