Matthew K. Hensley
According to research published in JAMA, nearly one-quarter of all maternal deaths in the United States from 2013 to 2016 were related to sepsis, and more than a third of those deaths occurred after hospital discharge. Overall, maternal sepsis occurred in around 0.04% of deliveries in the U.S., the researchers reported.
“Maternal sepsis, a life-threatening infection with organ dysfunction, is rare but associated with [a high mortality rate] during both childbirth and the postpartum period,” Matthew K. Hensley, MD, MPH, a pulmonary and critical care medicine fellow at the University of Michigan, told Infectious Disease News. “Half of sepsis episodes and sepsis-related deaths occurred in the postpartum period.”
Hensley and colleagues assessed the outcomes and incidence of maternal sepsis within 42 days of delivery hospitalization discharge using all-payer data from the National Readmissions Database, which aggregates all-payer hospital discharges from 27 states representing 57.8% of the U.S. population, they explained.
They identified single or multiple live-birth and stillbirth delivery hospitalizations from 2013 to 2016 and excluded ectopic pregnancies, molar pregnancies and abortions. They further limited index hospitalizations to patients with a January through October discharge to allow for 42-day follow-up in the yearly data sets, they wrote. They defined maternal death as in-hospital mortality occurring during index hospitalization or within 42 days of delivery hospitalization discharge and maternal sepsis as sepsis occurring during delivery hospitalization or during readmission within 42 days of delivery discharge.
Among 5,957,678 total delivery hospitalizations, 2,905 were complicated by sepsis (0.038%; 95% CI, 0.037%-0.04%) — 49.8% (95% CI, 47.7%-52%) during delivery hospitalization and 50.3% (95% CI, 48.1%-52.4%) after delivery discharge, according to the researchers. A total of 408 delivery hospitalizations (0.007%; 95% CI, 0.006%-0.007%) were followed by maternal death, and 95 (22.6%; 95% CI, 18.7%-27.1%) of these were related to sepsis — 17.3% (95% CI, 13.2%-22.4%) during delivery hospitalization and 38.1% (95% CI, 29.0%-48.1%) after delivery discharge.
“Though difficult to detect, we as providers need to remain vigilant in our screening and detection of sepsis because of the high associated mortality,” Hensley said. “It is also important for providers to know that half of cases occur in the postpartum period.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.