More needs to done to identify and initiate treatment of sepsis in pregnant women to reduce maternal mortality, says Professor James Walker in his plenary lecture today at the Royal College of Obstetricians and Gynaecologists (RCOG) World Congress in Hyderabad, India.
According to the RCOG’s Green-top Guideline on bacterial sepsis in pregnancy, severe sepsis has a mortality rate of 20-40%, which increases to 60% if septic shock develops in patients, making identification of symptoms and early management key to tackling this major health problem, says Professor Walker.
With 2015 drawing near, the UN's Millennium Development Goals are coming to the fore with MDG4, relating to the reduction of maternal mortality ratios around the world, having made significant progress by nearly halving maternal mortality since 1990. However, this figure can still be reduced further by raising awareness of the major causes and how to identify and treat them early, says Professor Walker.
In his lecture, 'Tackling Sepsis in Obstetrics', Professor Walker identifies sepsis, the potentially life-threatening complication of an infection, as one of the commonest forms of maternal death and morbidity in pregnancy, not only in developing countries such as India but in the UK, where it was the leading cause of direct deaths in the 2011 Confidential Enquiry into maternal deaths.
According to Professor Walker, this is partly due to the increased susceptibility that pregnant women have to infection, both with sustaining an initial infection and dying from it once infected. He identifies the main causes of sepsis in pregnancy as infections resulting from prolonged ruptured membranes and labour, c-sections, miscarriage and early pregnancy complications.
Surgical site infections (SSIs) following a c-section, for example, is a common cause of pregnancy-related sepsis, says Professor Walker, which is a major concern for both patients and healthcare systems in all countries. He stresses that this is not just a problem that occurs in under-resourced birth settings but in countries like the UK, where it is generally considered safe to give birth, with one in 10 of all women undergoing a c-section experiencing an SSI and the risk increasing further to one in five for obese women.
Professor Walker emphasises that the best way to address this problem is through increasing awareness among all healthcare professionals, and ensuring maternity units have preventative measures in place, such as guidelines on hygiene, aseptic techniques, sterile instruments, prophylactic antibiotics in identified high-risk patients.
Professor Walker said:
“Sepsis is not just a health challenge in developing countries where under-resourced birth settings can be the cause for many preventable infections and further complications in pregnant women. This is a problem that is affecting women the world-over in places that are generally considered safe to give birth.
“Routine procedures, like c-sections, are major contributors to the rates of sepsis in pregnant women in all countries, and this is something that healthcare professionals need to be aware of.
“Identifying patients who are most at risk, such as women with co-morbidities including diabetes or obesity, along with preventative measures within birth settings, such a simple hygiene rules on hand-washing, can go a long way to preventing sepsis.
“Additionally, timing must be stressed when it comes to the management and treatment of sepsis, with good observations, multi-disciplinary care and the appropriate antibiotics given at an early stage key to getting the best possible health outcomes for the patient.”
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Professor James Walker is a Professor at the Department of Obstetrics and Gynaecology, St James University Hospital and Honorary Consultant, SJUH Trust in Leeds, UK. He was Senior Vice President at the RCOG from 2010–2013 as the head of the Global Health Unit where he planned the College's Global Health Strategy.
Read the RCOG Green-top Guideline on Bacterial sepsis in pregnancy and the Green-top Guideline on Bacterial sepsis following pregnancy.