REVIEW ARTICLE

Obstetrics and Gynecology

doi: 10.25005/2074-0581-2023-25-2-248-259
EPIDEMIOLOGY AND RISK FACTORS FOR MATERNAL SEPSIS

D.A. Saydalieva, M.F. Dodkhoeva, R.A. Abdullaeva

Department of Obstetrics and Gynecology № 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: In modern medicine suppurative diseases of puerperas are among the most significant medical and social problems of obstetrics, occupying a leading position in the structure of maternal morbidity and mortality throughout the world. High incidence, an upward trend, a growing number of cases of cesarean sections (CS), insufficient detection and registration, along with obstetric aggression characterize these formidable complications that can occur during pregnancy or in the postpartum period. According to the literature data, in spite of the high relevance of the problem, research on the incidence of postpartum purulent inflammatory complications, risk factors for their development, clinical picture, diagnosis, prevention, and treatment, as well as the algorithm for managing patients with these complications in Tajikistan is scarce.

Keywords: Postpartum period, postpartum infection, postpartum suppurative diseases, sepsis, risk factors for sepsis.

Download file:


References
  1. VOZ. Ostanovit' sepsis, v tsentre vnimaniya global'nogo soobshchestva zdravookhraneniya: VOZ. Global'naya initsiativa po materinskomu i neonatal'nomu sepsisu [WHO. Stopping sepsis at the center of the global health community: WHO. Global Initiative on Maternal and Neonatal Sepsis]. 2017. https://srhr.org/sepsis/es/resources/
  2. McKinley LP, Wen T, Gyamfi-Bannerman C, Wright JD, Goffman D, Sheen JJ, et al. Hospital safety-net burden and risk for readmissions and severe maternal morbidity. Am J Perinatol. 2021;38(S01):e359-e366. https://doi. org/10.1055/s-0040-1710544
  3. Grunskaya AS, Kuznetsova IA, Kachalina TS, Borovkova LV, Kontorshchikova EYu, Zinovieva MS, i dr. Akusherskiy sepsis – mnogoobrazie simptomov, trudnosti diagnostiki (Klinicheskiy sluchay) [Obstetric sepsis – variety of symptoms, diagnostic difficulties (Clinical case)]. Meditsinskiy al'manakh. 2017;6:28-30.
  4. Radzinskiy VE. Akusherskaya agressiya [Obstetric aggression]. Moscow, RF: Status Praesens; 2017. 872 p.
  5. Say L, Chou D, Gemmill A, Tunçalp O, Moller A.B. Global causes of maternal death: A WHO systematic analysis. Lancet. Glob Health. 2014;2(6):e323-33. https://doi.org/10.1016/S2214-109X(14)70227-X
  6. Boushra M, Rahman O. Postpartum Infection. 2022 Jul 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
  7. Barinov SV, Blauman ES, Tirskaya YuI, Shkabarnya LL, Popova LD, Medyannikova LV. Faktory riska razvitiya i osobennosti techeniya poslerodovogo endometrita [Risk factors for the development and course of postpartum endometritis]. Mat' i ditya v Kuzbasse. 2017;2:22-8.
  8. Mercedes B, Vicky NP, Marcus JR, Arri C, David L, João PS, Ahmet MG. Towards a consensus definition of maternal sepsis: Results of a systematic review and expert consultation. Reprod Health. 2017;14(1):67. https://doi.org/10.1186/ s12978-017-0321-6
  9. The American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Optimizing postpartum care. Obstet Gynecol. 2018; 131(5):e140-50. https://doi.org/10.1097/aog.000000000002633
  10. Radzinskiy VE, Knyazev SA. Nastoyatel'nye rekomendatsii VOZ o snizhenii doli kesarevykh secheniy [Strong WHO recommendations to reduce the proportion of caesarean sections]. Status Praesens. 2015;3:11-20.
  11. Davydov AI, Podtetenev AD. Sovremennyy vzglyad na akusherskiy peritonit s pozitsii khirurgicheskoy taktiki [A modern view of obstetric peritonitis from the standpoint of surgical tactics]. Arkhiv akusherstva i ginekologii. 2014;1:44-8.
  12. Krasnopolskiy VI, Logutova LS, Buyanova S.N, Chechneva MA, Akhvlediani KN. Rezul'taty operativnoy aktivnosti v sovremennom akusherstve [The results of operational activity in modern obstetrics]. Zhurnal akusherstva i zhenskikh bolezney. 2015;14(2):53-7.
  13. Ali A, Lamont RF. Recent advances in the diagnosis and management of sepsis in pregnancy. F1000Res. 2019;8:F1000.
  14. Smirnova SS, Egorov IA, Golubkova AA. Gnoyno-septicheskie infektsii u rodil'nits. Chast' 1. Rasprostranyonnost', faktory riska, epidemiologicheskiy nadzor (obzor literatury) [Purulent-septic infections in puerperas. Part 1. Prevalence, risk factors, epidemiological surveillance (literature review)]. Zhurnal mikrobiologii, epidemiologii i immunologii. 2022;99(1):109-25.
  15. Barinov SV, Blauman ES, Tirskaya YuI, Shkabarnya LL, Popova LD, Medyannikova LV. Faktory riska razvitiya i osobennosti techeniya poslerodovogo endometrita [Risk factors for the development and course of postpartum endometritis]. Mat' i ditya v Kuzbase. 2017;2:22-8
  16. Faure K, Dessein R, Vanderstichele S, Subtil D. Endométrites du post-partum. RPC infections génitales hautes CNGOF et SPILFPostpartum endometritis: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines. Gynécologie Obstétrique Fertilité & Sénologie. 2019;47(5):442-50. https://doi.org/10.1016/j. gofs.2019.03.013
  17. Samoylova TE, Kokhno NI, Dokudaeva ShA. Mikrobnye assotsiatsii pri poslerodovom endometrite [Microbial associations in postpartum endometritis]. RMZh. Meditsinskoe obozrenie. 2018;2(10):6-13.
  18. Apresyan SV, Dimitrova VI, Slyusareva OA. Diagnostika i lechenie poslerodovykh gnoyno-septicheskikh zabolevaniy [Diagnosis and treatment of postpartum purulent-septic diseases]. Doktor.Ru. 2018;6:17-24. https://doi. org/10.31550/1727-2378-2018-150-6-17-24
  19. Escobar, MF, Echavarría MP, Zambrano MA, Ramos I, Kusanovic JP. Maternal sepsis. American Journal of Obstetrics & Gynecology MFM. 2020;2(3):100149. https://doi.org/10.1016/j.ajogmf.2020.100149
  20. Tully KP, Stuebe AM, Verbiest SB. The fourth trimester: a critical transition period with unmet maternal health needs. Am J Obstet Gynecol. 2017;217(1):37- 41. https://doi.org/10.1016/j.ajog.2017.03.032
  21. Bamfo J. Managing the risks of sepsis in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27:583-95.
  22. Devyatova EA. Akusherskiy sepsis. Analiticheskiy obzor [Obstetric sepsis. Analytical review]. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie. 2015;3:33-44.
  23. Hajar R. The air of history (part II) medicine in the middle Ages. Heart Views. 2012;13(4):158-62. https://doi.org/10.4103/1995-705X.105744
  24. Loudon I. Ignaz Phillip Semmelweis’ studies of death in child birth. J R Soc Med. 2013;106(11):461-3. https://doi.org/10.1177/0141076813507844
  25. Morgoshiya TSh, Syroezhin NA. U istokov antiseptiki: zhiznennyy put' legendarnogo professora Ignatsa Zemmel'veysa (1818-1865). K 200-letiyu so dnya rozhdeniya [At the origins of antiseptics: The life path of the legendary professor Ignaz Semmelweis (1818-1865). To the 200th anniversary of the birth]. Rossiyskiy vestnik akushera-ginekologa. 2018;18(3):1048. https://doi.org/10.17116/ rosakush2018182104-108
  26. Malushko AV, Shevelyova TS, Tkachuk AG, Kalinina EA, Pervunina TM, Zubareva TM, i dr. Akusherskiy sepsis (obzor literatury) [Obstetric sepsis (literature review)]. Akusherstvo i ginekologiya Sankt-Peterburga. 2017;2:53-7.
  27. Smirnova SS, Golubkova AA, Alimov AV, Akimkin VG. Vnutriutrobnye infektsii novorozhdyonnykh kak markyor epidemicheskogo neblagopoluchiya v uchrezhdeniyakh rodovspomozheniya [Intrauterine infections of newborns as a marker of epidemic problems in obstetric institutions]. Epidemiologiya i vaktsinoprofilaktika. 2019;18(5):42-9. https://doi.org/10.31631/2073-3046- 2019-18-5-42-49
  28. Naygovzina NB, Popova AYu, Biryukova EE, Ezhlova EB, Igonina EP, Pokrovskiy VI, i dr. Optimizatsiya sistemy mer bor'by i profilaktiki infektsiy, svyazannykh s okazaniem meditsinskoy pomoshchi v Rossiiskoy Federatsii [Optimization of the system of measures to combat and prevent infections associated with the provision of medical care in the Russian Federation]. ORGZDRAV: novosti, mneniya, obucheniya. Vestnik VShOUZ. 2018;1:17-26.
  29. Chan GJ, Lee AC, Baqui AH, Tan J. Risk of early-onset neonatal infection with maternal infection or colonization: A global systematic review and meta-analysis. PLoS Med. 2013;10(8):e1001502. https://doi.org/10.1371/journal. pmed.1001502
  30. Gabitova NA, Kedrova AG, Zakharova MA, Belousova TN, Kucherova ON. Materinskiy sepsis: novoe mezhdunarodnoe opredelenie – novye vozmozhnosti dlya uluchsheniya iskhodov [Maternal sepsis: A new international definition – new opportunities for improving outcomes]. Farmateka. 2022;6:57-62.
  31. Burdick H, Pino E, Gabel-Comeau D, McCoy A, Gu C, Roberts J, et al. Effect of a sepsis prediction algorithm on patient mortality, length of stay and readmission: A prospective multicentre clinical outcomes evaluation of real-world patient data from US hospitals. BMJ Health Care Inform. 2020; 27(1):e100109. https://doi.org/10.1136/bmjhci-2019-100109
  32. Knight M, Chiocchia V, Partlett C, Rivero-Arias O, Hua X, Hinshaw K, et al. (2019). ANODE Collaborative Group. Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): A multicentre randomised controlled trial. Lancet. 2019;393(10189):2395-403. https://doi.org/10.1016/ S0140-6736(19)30773-1
  33. Black RE, Laxminarayan R, Temmerman M, Walker N, eds. Reproductive, maternal, newborn, and child health: Disease control priorities. 3rd ed. (Vol. 2). Washington, USA: The International Bank for Reconstruction and Development/The World Bank; 2016.
  34. Royal College of Obstetricians and Gynaecologists. Sepsis in pregnancy, bacterial (Green-top Guideline No. 64a); 2012. URL: https://www. rcog.org.uk/en/ guidelines-research-services/ guidelines/gtg64a/
  35. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10. https://doi.org/10.1001/ jama.2016.0287
  36. Artymuk NV. Sepsis v akusherstve [Sepsis in obstetrics]. Akusherstvo i ginekologiya. 2017;3:61-5.
  37. Contro E, Jauniaux E. Puerperal sepsis: What has changed since Semmelweis's time. BJOG. 2017;124(6):936.
  38. Anderson BL. Puerperal group a streptococcal infection: Beyond Semmelweis. Obstet Gynecol. 2014;123(4):874-82. https://doi.org/10.1097/ AOG.0000000000000175
  39. Snyder C, Barton J, Habli M, Sibai B. Severe sepsis and septic shock in pregnancy: Indications for delivery and maternal and perinatal outcomes. J Matern Fetal Neonatal Med. 2013;26(5):503-6.
  40. Hensley MK, Bauer ME, Admon LK, Prescott HC. Incidence of maternal sepsis and sepsis-related maternal deaths in the United States. JAMA. 2019;322(9):890-2. https://doi.org/10.1001/jama.2019.9818
  41. Kasymova ZN, Radzhabova MA, Saidova MM, Makhmudova SM, Gazibekova EM. Gnoyno-vospalitel'nye zabolevaniya v akusherstve [Purulent-inflammatory diseases in obstetrics]. Mat' i ditya. 2020;1:30-5.
  42. Buddeberg BS, Aveling W. Puerperal sepsis in the 21st century: Progress, new challenges and the situation worldwide. Postgrad Med J. 2015;91(1080):572-8. https://doi.org/10.1136/ postgradmedj-2015-133475
  43. Shields A, Assis V, Halscott T. Top 10 pearls for the recognition, evaluation, and management of maternal sepsis. Obstetrics and Gynecology. 2021;138(2):289. https://doi.org/10.1097/AOG.0000000000004471
  44. Bauer ME, Bateman BT, Bauer ST, Shanks AM, Mhyre JM. Maternal sepsis mortality and morbidity during hospitalization for delivery: Temporal trends and independent associations for severe sepsis. Anesth Analg. 2013;117(4):944-50. https://doi.org/10.1213/ANE.0b013e3182a009c3
  45. Ivannikov NY, Mitichkin AE, Dimitrova VI, Slyusareva OA, Khlynova SA, Dobrokhotova YuE. Sovremennye podkhody v lechenii poslerodovykh gnoyno-septicheskikh zabolevaniy [Modern approaches in the treatment of postpartum purulent-septic diseases]. Meditsinskiy sovet. 2019;7:58-69. https://doi. org/10.21518/2079-701X-2019-7-58-69
  46. Albright CM, Ali TN, Lopes V, Rouse DJ, Anderson BL. The sepsis in obstetrics score: A model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol. 2014;211(1):39.e1-8. https://doi.org/10.1016/j.ajog.2014.03.010
  47. Organization de los estados americanos. Introduction: La desigualdad y la pandemia del COVID-19 en las Americas. In: Organization de los estados americanos. Guia Practica de Respuestas Inclusivas y con Enfoque de Derechos ante el COVID-19 en las Americas. Washington, USA: OEA; 2020. 103 p.
  48. Paruk F. Infection in obstetric critical care. Best Pract Res Clin Obstet Gynaecol. 2008;22:865-83.
  49. Yerba K, Failoc-Rojas V, Zeña-Ñañez S, Valladares-Garri do M. Factors associated with surgical site infection in post-cesarean section: A case-control study in a Peruvian hospital. Ethiop J Health Sci. 2020;30(1):95-100. https://doi. org/10.4314/ejhs.v30i1.12
  50. Cornelissen L, Woodd S, Shakur-Still H, Fawole B, Noor S, Etuk S, et al. Secondary analysis of the WOMAN trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage. Int J Gynaecol Obstet. 2019;146(2):231-7. https://doi.org/10.1002/ijgo.12860
  51. Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet Gynecol. 2017;130(4):e168-e186. https://doi. org/10.1097/AOG.0000000000002351

Author information:


Saydalieva Dilafruz Alovuddinovna,
PhD Student of the Department of Obstetrics and Gynecology № 1, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4979-7896
E-mail: dilaksaidali@gmail.com

Dodkhoeva Munavvara Fayzulloevna,
Academician of the National Academy of Sciences of Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Obstetrics and Gynecology № 1, Avicenna Tajik State Medical University
Researcher ID: AAC-4784-2019
ORCID ID: 0000-0001-9373-4318
SPIN: 9749-6174
Author ID: 313026
E-mail: dodkho2008@mail.ru

Abdullaeva Rano Abdugafarovna,
Candidate of Medical Sciences, Associate Professor, Head of the Department of Obstetrics and Gynecology № 1, Avicenna Tajik State Medical University
ORCID ID: 0000-0003-3100-2343
E-mail: ranoshechka74@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Dodkhoeva Munavvara Fayzulloevna
Academician of the National Academy of Sciences of Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Obstetrics and Gynecology № 1, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 612606

E-mail: dodkho2008@mail.ru

Materials on the topic: