Seminars in perinatology最新文献

{"title":"Sepsis in obstetric care for the emergency clinician: A review","authors":"Anna Stacy ,&nbsp;Puloma Bishnu ,&nbsp;Rachel E. Solnick","doi":"10.1016/j.semperi.2024.151980","DOIUrl":"10.1016/j.semperi.2024.151980","url":null,"abstract":"<div><div>Sepsis remains a leading cause of mortality among pregnant and recently pregnant patients, rendering it a subject of vital importance to emergency clinicians in the US. However, death by sepsis has been found to be largely preventable with prompt and appropriate intervention. This narrative review provides a summary of the physiologic, epidemiologic, and systemic factors specific to obstetric sepsis that contribute to delays in diagnosis and treatment. Additionally, it provides a framework for emergency department providers to approach infection identification, antimicrobial selection, and appropriate resuscitation prior to disposition.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151980"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Quality improvement efforts directed at optimal umbilical cord management in delivery room” [Seminars in Perinatology. 8/3 (year 2024) 151905]","authors":"Priya Jegatheesan ,&nbsp;Henry C. Lee ,&nbsp;Andrea Jelks ,&nbsp;Dongli Song","doi":"10.1016/j.semperi.2024.151983","DOIUrl":"10.1016/j.semperi.2024.151983","url":null,"abstract":"","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151983"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term sequelae and management following obstetric sepsis","authors":"Anna K Daoud ,&nbsp;Corrina Oxford-Horrey","doi":"10.1016/j.semperi.2024.151981","DOIUrl":"10.1016/j.semperi.2024.151981","url":null,"abstract":"<div><div>The long-term consequences of obstetric sepsis have been a growing area of concern requiring attention. This narrative review summarizes the existing literature on the long-term sequelae of sepsis, with a focus on the antepartum and postpartum periods. In this article, we discuss risk factors for and epidemiology of post-sepsis syndrome (PSS) and related long-term medical conditions. We include recommendations for screening for PSS and management strategies involving multidisciplinary teams. PSS and other long-term medical and psychological sequelae of sepsis impact individuals and their communities greatly, including the obstetric population. There is a need for improved identification, management, and coordination of care for long-term complications of sepsis. Gaps in the literature for future study include identifying specific needs of the obstetric population in the weeks, months, and years following a sepsis event.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151981"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric sepsis: Clinical pearls for diagnosis and management","authors":"Faranak Behnia ,&nbsp;Chasey I. Omere ,&nbsp;Corey C. Clifford ,&nbsp;Luis D. Pacheco","doi":"10.1016/j.semperi.2024.151975","DOIUrl":"10.1016/j.semperi.2024.151975","url":null,"abstract":"<div><div>Sepsis is a leading cause of maternal morbidity and mortality worldwide. Early recognition and treatment improve outcomes. Multiple sepsis diagnostic screening tools are available and may be used in clinical practice; however, early thorough bedside evaluation of the patient is fundamental. Obstetricians should be able to recognize sepsis and promptly initiate potentially life-saving treatments, such as fluid resuscitation, vasopressors, broad-spectrum antibiotics, and early source control. It is recommended that obstetrical care, including delivery timing, not be altered solely due to the diagnosis of sepsis.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151975"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiologic changes of pregnancy and considerations for screening and diagnosis of sepsis","authors":"James Conwell ,&nbsp;Mariam Ayyash ,&nbsp;Harjot K. Singh ,&nbsp;Dena Goffman ,&nbsp;Benjamin L. Ranard","doi":"10.1016/j.semperi.2024.151973","DOIUrl":"10.1016/j.semperi.2024.151973","url":null,"abstract":"<div><div>Obstetric sepsis is a significant cause of morbidity and mortality in pregnant people worldwide. Initial evaluation and timely intervention are crucial to improving outcomes for birthing persons and their newborns. While many of the therapies and interventions for peripartum sepsis are consistent with the general population, there are considerations unique to pregnancy. Stabilization of the septic pregnant or immediately postpartum patient requires an understanding of the physiologic changes of pregnancy, hemodynamic changes during labor, and infections specific to pregnancy. We will review the interaction between pregnant physiology and sepsis pathophysiology, and how this can guide screening and diagnosis.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151973"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving care for obstetric sepsis: Challenges, clinical key points, and innovation","authors":"Lisa Nathan ,&nbsp;Melissa E Bauer","doi":"10.1016/j.semperi.2024.151982","DOIUrl":"10.1016/j.semperi.2024.151982","url":null,"abstract":"","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151982"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and community centered approaches to sepsis among birthing people","authors":"Briana T. Richardson ,&nbsp;Ana Cepin ,&nbsp;Stephanie Grilo ,&nbsp;Regan A. Moss ,&nbsp;Madeleine Dorval Moller ,&nbsp;Sevonna Brown ,&nbsp;Dena Goffman ,&nbsp;Alexander Friedman ,&nbsp;Uma M. Reddy ,&nbsp;Kelli Stidham Hall","doi":"10.1016/j.semperi.2024.151974","DOIUrl":"10.1016/j.semperi.2024.151974","url":null,"abstract":"<div><div>Sepsis is the second leading cause of maternal death in the U.S. For racial and ethnic minoritized birthing people, especially those who are Black and living in underserved communities, labor and postpartum are particularly vulnerable risk periods. To reduce sepsis-related morbidity and mortality and promote maternal health equity, community co-led, and co-designed interventions are urgently needed. In this commentary, we introduce the design and goals of our EnCoRe MoMS study as an exemplar for employing community based participatory research principals iteratively throughout the research process and integrated across all study aims. We also highlight our early lessons learned and recommendations for best practices. Our novel model and ongoing work have implications for scaling academic-community research partnerships for other causes of severe maternal morbidity and maternal health equity nationally.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151974"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing an obstetric sepsis bundle in a large academic hospital system","authors":"Lejdisa Stanaj ,&nbsp;Dena Goffman ,&nbsp;Brianne Genow ,&nbsp;Lynne Meccariello ,&nbsp;Julie Ewing ,&nbsp;Isaac Michaels","doi":"10.1016/j.semperi.2024.151977","DOIUrl":"10.1016/j.semperi.2024.151977","url":null,"abstract":"<div><div>For the purposes of this review, obstetric sepsis refers to sepsis (from all causes, including non-obstetric such as pneumonia) in pregnant or postpartum patients, which was previously described as maternal sepsis. Obstetric sepsis poses a significant threat to pregnant, birthing, and postpartum individuals, contributing prominently to maternal mortality and morbidity despite being largely preventable<span><span>¹</span></span>. In response to identified gaps in sepsis management, particularly the lack of specific protocols tailored to obstetric populations, New York-Presbyterian undertook a system-wide initiative to implement a comprehensive sepsis bundle. This initiative included the development of new criteria for identifying sepsis in obstetric patients, the creation of electronic medical record (EMR) alerts aligned with obstetric-specific indicators, and the establishment of a structured sepsis management algorithm.</div><div>The project involved collaboration across eight hospital campuses within the New York-Presbyterian system, aiming to standardize and improve the early recognition and treatment of sepsis in maternal care. Key components included rigorous data analysis to select appropriate sepsis criteria, simulation-based training to familiarize clinical teams with the new algorithm, and continuous refinement of alert systems to mitigate alarm fatigue and enhance responsiveness.</div><div>Post-implementation evaluation revealed a significant reduction in preventable morbidity related to sepsis, accompanied by the identification of additional gaps in fever and chorioamnionitis management. These findings prompted the development of new clinical guidelines to further enhance patient safety. Challenges encountered included adapting sepsis criteria to balance sensitivity and specificity, as well as integrating trauma-informed care principles into clinical practice.</div><div>This project underscores the effectiveness of tailored quality improvement efforts in maternal health, emphasizing the critical role of proactive interventions in enhancing patient outcomes and safety within obstetric settings. Ongoing efforts focus on monitoring process metrics through a dedicated sepsis dashboard and advancing education on trauma-informed care principles, highlighting the continued commitment to sustained improvement in maternal health outcomes.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151977"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sepsis as a driver of excess severe maternal morbidity and mortality in the rural United States","authors":"Annika Brakebill ,&nbsp;Hadley R. Katzman ,&nbsp;Lindsay K. Admon","doi":"10.1016/j.semperi.2024.151978","DOIUrl":"10.1016/j.semperi.2024.151978","url":null,"abstract":"<div><div>Obstetric sepsis is a leading cause of preventable maternal morbidity and mortality. Pregnant and postpartum patients in rural settings experience disproportionate rates of sepsis and other forms of severe maternal morbidity. Although there have been recent advances in addressing preventable morbidity and mortality from sepsis in the general adult population, combating excess rates of sepsis in the obstetric population, particularly among rural patients, will require targeted clinical and policy interventions.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151978"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in obstetric sepsis and strategies to prevent them","authors":"Dominique Arce ,&nbsp;Allison Lee","doi":"10.1016/j.semperi.2024.151979","DOIUrl":"10.1016/j.semperi.2024.151979","url":null,"abstract":"<div><div>Severe morbidity and mortality associated with sepsis in obstetric care occur even among those presumed to be at low risk, are highly preventable and deserve critical public health prioritization. Continued research is warranted that focuses on the development and performance assessment of screening tools, standardizing diagnostic criteria, and understanding how to implement and sustain quality improvement practices to support timely recognition and treatment, as well as equitable healthcare practices to improve maternal outcomes across diverse populations</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151979"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}