Bartlett L A, LeFevre A E, Mir F, Soofi S, Arif S, Mitra D K, Quaiyum M A, Shakoor S, Islam M S, Connor N E, Winch P J, Reller M E, Shah R, El Arifeen S, Baqui A H, Bhutta Z A, Zaidi A, Saha S, Ahmed S A
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
Reprod Health. 2016 Feb 25;13:16. doi: 10.1186/s12978-016-0124-1.
Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk.
METHODS/DESIGN: The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics.
This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.
产后败血症是产后三至七天内大多数孕产妇死亡的原因，在此期间，大多数产妇，即使是那些在医疗机构分娩的产妇，也都在家中。未经治疗的妇女病死率非常高。患病妇女的新生儿感染风险显著更高。
方法/设计：本研究的目标是：（1）创建、实地测试并验证一种工具，供社区卫生工作者提高对疑似产褥期败血症的诊断准确性；（2）测量发病率并确定相关风险因素；（3）描述致病病原体及抗菌药敏模式。这项前瞻性队列研究基于南亚新生儿感染病因研究，在三个地点开展：孟加拉国锡尔赫特以及巴基斯坦卡拉奇和马蒂亚里。形成性研究确定了当地对产后败血症症状和体征的了解情况，并进行了系统的文献综述，以设计一种诊断工具，供社区卫生工作者在产后十次家访期间使用。疑似产后败血症病例被转介给研究医生进行独立评估，从而验证该工具。收集临床标本，包括尿液、血液和子宫内膜材料，用于病因评估和抗生素敏感性测试。所有产褥期败血症妇女均接受了适当的抗生素治疗。
这是第一项基于大规模人群的研究，将基于社区的新生儿败血症诊断、转诊和治疗监测扩展至包括孕产妇产后败血症。研究活动将导致开发并验证一种供资源匮乏国家的社区卫生工作者使用的诊断工具。了解产后败血症的流行病学和微生物学将为预防和治疗策略提供信息，并增进对孕产妇和新生儿感染之间联系的理解。
