Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
Infect Dis Ther. 2014 Dec;3(2):175-89. doi: 10.1007/s40121-014-0037-7. Epub 2014 Sep 9.
Pregnancy is associated with an increased risk of infection related to its associated mechanical and physiological changes. Sepsis remains among the top causes of maternal death worldwide and is associated with substantial maternal morbidity. However, there are sparse data on pregnancy-associated severe sepsis (PASS), related in part to infrequent reports, varying case definitions and methodological approach, small cohort size, and often limited focus on severe sepsis in selected phases of pregnancy outcomes. Available reports vary, but indicate that PASS is a rare but likely increasing complication, and it is more likely to develop with increased maternal age, among minority women, the poor, those lacking health insurance, those with chronic illness or pregnancy-associated complications, and following invasive procedures. Obstetric sites of infection are the most prevalent, but non-obstetric infections often underlie pregnancy-associated severe sepsis, though the source of infection is often not readily apparent during initial care. Women with PASS can have a rapidly fatal course and require heightened clinician vigilance for early diagnosis and timely effective intervention. Nevertheless, available reports raise concerns about prevalent substandard care of these patients, contributing to adverse outcomes. The case fatality of PASS appears lower than that in the general population with severe sepsis, while the long-term outcomes of survivors remain unknown.
妊娠与相关的机械和生理变化相关的感染风险增加有关。败血症仍然是全世界孕产妇死亡的主要原因之一，并且与大量孕产妇发病率有关。然而，关于妊娠相关严重败血症 (PASS) 的数据很少，部分原因是报告频率低、病例定义和方法学方法不同、队列规模小，并且通常仅限于在妊娠结局的特定阶段关注严重败血症。现有报告有所不同，但表明 PASS 是一种罕见但可能增加的并发症，并且随着产妇年龄的增加、少数族裔妇女、贫困、没有医疗保险、患有慢性疾病或与妊娠相关的并发症以及进行侵入性操作，其发生的可能性更大。产科感染部位最常见，但非产科感染通常是妊娠相关严重败血症的基础，尽管在初始治疗期间，感染源通常不易察觉。患有 PASS 的女性可能会迅速致命，需要临床医生高度警惕以早期诊断和及时有效的干预。尽管如此，现有报告还是对这些患者普遍存在的护理标准不足表示担忧，这导致了不良后果。PASS 的病死率似乎低于一般人群中严重败血症的病死率，而幸存者的长期预后尚不清楚。
