By the bioMérieux Connection Editors
Despite being highly preventable, maternal sepsis continues to be a major cause of death for pregnant or recently pregnant women around the world. Pregnancy-related infections and sepsis are the third most common cause of maternal deaths and the underlying cause of 15% of all maternal deaths.
Sepsis is a life-threatening condition that occurs when the body’s response to infection injures its own tissues and organs. According to the World Health Organization (WHO), “as infections frequently complicate serious diseases, sepsis is a final common pathway to death from both communicable and non-communicable diseases around the world.” When sepsis occurs during pregnancy or after giving birth, it is known as maternal sepsis.
Physiological and immunological changes that occur during pregnancy can predispose women to infection. Illnesses associated with increased severity among pregnant women include influenza and HPV. Pregnant women can also be more susceptible to infections such as listeria or malaria. In addition, women who undergo caesarean section delivery, pre-term delivery, or have chronic illnesses have a higher risk of developing a prenatal infection. Undetected or poorly managed maternal infections can lead to sepsis or death for the mother and an increased likelihood of infection in the newborn.
The WHO’s statement on maternal sepsis says that strategic approaches to reducing maternal deaths over the last decade have mainly focused on clinical interventions—particularly to handle postpartum hemorrhage and hypertensive disorders. Maternal sepsis has received less attention, research, and programming, despite it being such a common cause of maternal death.
Maternal sepsis may be prevented by awareness, quick diagnosis, and rapid treatment of infections. “The effective prevention, early identification and adequate management of maternal and neonatal infections and sepsis can contribute to reducing the burden of infection as an underlying and contributing cause of morbidity and mortality,” according to the authors of The Global Maternal Sepsis Study and Awareness Campaign (GLOSS): Study Protocol. This study aimed to determine actionable criteria for identifying severe maternal infection in order to allow for timely management and improved patient outcomes.
Additional maternal sepsis prevention methods include access to quality care during pregnancy and birth, clean water, the correct medications, and proper infection prevention and control. Healthcare workers should be trained to recognize infection, signs of sepsis, and to treat the infection properly. Maternal deaths associated with infection are higher in low- and middle-income countries (>10% of maternal deaths) compared to high-income countries (<5%), and the GLOSS study also provided insight to help to close this gap.
The lead author on the GLOSS study, Mercedes Bonet, has developed her career around maternal and neonatal health and is a perinatal health epidemiologist in the Department of Reproductive Health and Research at the WHO. Bonet has conducted research and reviews on ways to maintain WHO recommendations on maternal and perinatal health, and factors that influence healthcare provider’s awareness of maternal sepsis. In 2018, she contributed to a review of what matters to women during childbirth. The review concluded that, “maternity care should be designed to fulfill or exceed women’s personal and socio-cultural beliefs and expectations.”
In 2017, the WHO and HRP joined with the Global Sepsis Alliance to host the ‘World Sepsis Congress Spotlight: Maternal and Neonatal Sepsis’. This free online congress highlighted neglected aspects of sepsis and attracted more than 8,000 registrations from 152 countries. This shows that in recent years, more has been done to spread awareness about maternal sepsis and shine a light on the issue. However, more research, education, and assistance is needed to solve the devastating problem that effects such a large portion of women and their children worldwide.
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