Characteristics and outcomes of obstetric patients with maternal sepsis requiring admission to a South African intensive care unit: A retrospective review

Abstract

Background. Maternal sepsis is a major cause of maternal mortality worldwide and constitutes one of the leading causes of preventable maternal mortality and morbidity. Puerperal sepsis following a caesarean delivery has been shown to be a leading cause of sepsis in women.  Objectives. To describe the epidemiology, risk factors, management interventions and maternal outcome of patients with maternal sepsis admitted to a South African (SA) intensive care unit (ICU) over a 2-year period.  Methods. We conducted a single-centre, retrospective review of data of 54 patients admitted to a tertiary referral ICU in SA with the diagnosis of maternal sepsis from 1 January 2015 to 31 December 2016. Clinical characteristics, management interventions and maternal outcomes of patients with maternal sepsis were described and assessed.  Results. There were 39 884 deliveries during the study period and 16 060 (40.3%) were by caesarean section (CS). Sepsis was diagnosed in 1.7% ( n =678) of the patients and 8.0% ( n =54) of these patients were admitted to ICU. The median (interquartile range (IQR)) maternal age was 30 (26 - 34) years. Sepsis post CS accounted for 50% ( n =27), sepsis post vaginal birth for 12.9% ( n =7), septic incomplete miscarriages for 24.0% ( n =13), sepsis post preterm deliveries for 9.2% ( n =5) and sepsis post exploratory laparotomy for ruptured ectopic pregnancy for 3.7% ( n =2). Coagulase-negative Staphylococcus was the most commonly isolated organism. The median (IQR) duration of ICU stay was 4 (2 - 6) days. All patients required mechanical ventilation. The mean (standard deviation (SD)) duration of ventilation was 2.5 (1.7) days. More than a quarter of women (29.6%; n =16) required inotropic support, while 90.7% ( n =49) required blood products and 9.2% ( n =5) required renal replacement therapy. Complications in ICU were metabolic acidosis (46.3%), acute kidney injury (40.7%), coagulopathy (25.9%), circulatory shock (12.9%), acute respiratory distress syndrome (9.2%), cardiac arrest (9.2%) and abnormal liver enzymes (7.4%). Mortality was 11.1% ( n =6).  Conclusions. Maternal sepsis remains a significant cause of morbidity and mortality. The identification of associated risk factors will help guide appropriate interventions.