T. Culling , C. Bertorelli , A. Strang , S. Oram , F. Faggian , S. Sharma , A. Ridgeway , Summia Zaher , Mario Labeta , Simon A. Jones , Luke C. Davies , John Watkins , Kate Siddall , Vikki Keeping , Kathryn Simpson , Maryanne Bray , Peter Ghazal , Sarah F. Bell , Rachel E. Collis
{"title":"Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study","authors":"T. Culling , C. Bertorelli , A. Strang , S. Oram , F. Faggian , S. Sharma , A. Ridgeway , Summia Zaher , Mario Labeta , Simon A. Jones , Luke C. Davies , John Watkins , Kate Siddall , Vikki Keeping , Kathryn Simpson , Maryanne Bray , Peter Ghazal , Sarah F. Bell , Rachel E. Collis","doi":"10.1016/j.ijoa.2025.104683","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis.</div></div><div><h3>Methods</h3><div>Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: ‘infection confirmed’, ‘infection unknown’ and ‘infection unlikely’. Differences in physiological and routine laboratory variables were investigated.</div></div><div><h3>Results</h3><div>Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between ‘infection confirmed’ (n=58) and ‘infection unlikely’ (n=17) showed statistical differences in temperature (<em>P</em> <0.001), neutrophil count (<em>P</em> =0.003) and leukocyte count (<em>P</em> =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, <em>P</em> <0.0001) with an optimal threshold of ≥37.5°C.</div></div><div><h3>Conclusion</h3><div>This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"63 ","pages":"Article 104683"},"PeriodicalIF":2.6000,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of obstetric anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0959289X2500055X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis.
Methods
Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: ‘infection confirmed’, ‘infection unknown’ and ‘infection unlikely’. Differences in physiological and routine laboratory variables were investigated.
Results
Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between ‘infection confirmed’ (n=58) and ‘infection unlikely’ (n=17) showed statistical differences in temperature (P <0.001), neutrophil count (P =0.003) and leukocyte count (P =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, P <0.0001) with an optimal threshold of ≥37.5°C.
Conclusion
This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered.
期刊介绍:
The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient.
• Original research (both clinical and laboratory), short reports and case reports will be considered.
• The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia.
• Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome.
The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.