BACKGROUND AND PURPOSE:

• Hensley et al. (JAMA, 2019) assessed incidence and outcomes of maternal sepsis in the United States within 42 days of delivery discharge

METHODS:

• Secondary data analysis
  • Data from the National Readmissions Database (NRD), from 2013 to 2016
  • Aggregates all-payer hospital discharges from 27 states
  • This data represents 57.8% of the US population
• Data inclusion criteria
  • Single or multiple live-birth and stillbirth
  • Excluded were ectopic pregnancies, molar pregnancies, and abortions
• Definitions
  • Maternal sepsis identified via diagnosis codes: Severe sepsis | Septic shock | Concurrent codes for sepsis and acute organ dysfunction
  • Maternal death defined as occurring during index delivery hospitalization or within 42 days of discharge
• Primary outcome
  • Incidence of maternal sepsis and sepsis-related mortality (overall and during and after delivery hospitalization)

RESULTS:

• 5,957,678 delivery hospitalizations | 32.5% cesarean deliveries
• Sepsis rates: 0.038% of deliveries (95% CI, 0.037% to 0.040%)
  • 49.8% occurred during delivery hospitalization
  • 50.3% occurred after delivery discharge
  • Sepsis readmissions occurred a mean of 13.6 (SD, 11.2) days after discharge from delivery hospitalization
• When comparing maternal sepsis episodes vs those that occurred after delivery, maternal sepsis episodes
  • Occurred in women with fewer comorbidities (P < .001)
  • Were less frequently associated with cesarean deliveries (P < .001)
  • Had a higher percentage of acute kidney dysfunction (P < .001)
  • Had a lower percentage of genitourinary infection (P < .001)
• 408 deliveries (0.007%) were followed by maternal death
  • 74.4% were during delivery hospitalization (95% CI, 69.6% to 78.6%)
  • 25.6% were after delivery discharge (95% CI, 21.4% to 30.4%)
• Overall, 22.6% of the maternal deaths were sepsis-related (95% CI, 18.7% to 27.1%) with more deaths occurring in the discharge group

CONCLUSION:

• In the US, maternal sepsis was involved in 0.04% of deliveries
• 23% of all maternal deaths were sepsis-related, with many occurring after discharge

Learn More – Primary Sources:

Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States

Related ObG Topics:

SMFM & CMQCC Guidelines: Making the Diagnosis of Sepsis in Pregnancy

SMFM & CMQCC Guidelines: Management of Sepsis in Pregnancy

Do Mandated Sepsis Procedures Reduce Sepsis-Related Deaths?

Maternal Near-Misses: An Investigation of Incidence and Causes

Pregnancy-Related Deaths in the U.S.: How Many are Preventable?