Bonet Mercedes, Nogueira Pileggi Vicky, Rijken Marcus J, Coomarasamy Arri, Lissauer David, Souza João Paulo, Gülmezoglu Ahmet Metin
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Department of Social Medicine and Department of Paediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
Reprod Health. 2017 May 30;14(1):67. doi: 10.1186/s12978-017-0321-6.
There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis.
All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego.
Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition "Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period". Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population.
The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of care (administration of antimicrobials and fluids, support of vital organ functions, and referral) and improve maternal outcomes.
为了更好地评估孕产妇脓毒症的负担、及时启动有效治疗并便于不同机构和国家之间进行比较，需要对孕产妇脓毒症给出清晰且可操作的定义。本研究的目的是回顾孕产妇脓毒症的定义和识别标准，并报告一次专家咨询的结果，以制定新的孕产妇脓毒症国际定义。
纳入所有提供孕产妇脓毒症定义和/或识别标准的原创及综述文章、世卫组织文件以及临床指南。2016年3月至4月，通过在线咨询对一个多学科国际专家小组进行了调查，了解他们对现有脓毒症定义的看法，包括为成人提出的脓毒症新定义（2016年脓毒症和脓毒性休克第三次国际共识定义）以及孕产妇脓毒症不同识别标准的重要性。该定义是在世卫组织和约翰霍普金斯大学布隆伯格公共卫生学院联合组织的专家面对面共识制定会议上，通过反复迭代过程达成一致的。
专家小组认为，使孕产妇脓毒症的定义标准化并使其与目前对成人脓毒症的理解保持一致，是改善孕产妇脓毒症负担评估的必要步骤。文献综述和专家咨询得出了世卫组织新的共识定义：“孕产妇脓毒症是一种危及生命的状况，定义为妊娠、分娩、流产后或产后期间因感染导致的器官功能障碍”。目前正在计划在大量国际人群中验证世卫组织新的孕产妇脓毒症定义。
新的孕产妇脓毒症定义的实施需要制定一套实用标准来识别脓毒症女性患者。这些标准应使临床医生能够专注于及时启动可操作的护理要素（给予抗菌药物和液体、支持重要器官功能以及转诊）并改善孕产妇结局。
