a Department of Obstetrics and Gynecology , Ryhov County Hospital , Jönköping , Sweden.
b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden.
Infect Dis (Lond). 2017 Oct;49(10):765-771. doi: 10.1080/23744235.2017.1341055. Epub 2017 Jun 20.
The objective was to estimate whether maternal obesity and/or obstetric interventions are associated with diagnosed maternal post-partum sepsis.
A retrospective observational cohort study including all deliveries in Sweden between 1997 and 2012 (N = 1,558,752). Cases of sepsis (n = 376) were identified by International Classification of Diseases, (ICD-10) codes A40, A41 and O 85 in the Medical Birth Register and the National Patient Register. The reference population was non-infected, and therefore, women with any other infection diagnosis and/or with dispensed antibiotics within eight weeks post-partum were excluded. Information on dispensed drugs was available in the prescribed drug Register. Women with sepsis were compared with non-infected women concerning maternal characteristics and obstetric interventions. Adjusted odds ratios (aOR) were determined using the Mantel-Haenszel technique. Adjustments were made for maternal age, parity and smoking.
Obese women (body mass index ≥30) had a doubled risk of sepsis (3.6/10,000) compared with normal weight women (2.0/10,000) (aOR 1.85 (95%CI: 1.37-2.48)). Induction of labour (aOR 1.44 (95%CI: 1.09-1.91)), caesarean section overall (aOR 3.06 (95%CI: 2.49-3.77)) and elective caesarean section (aOR 2.41 (95%CI: 1.68-3.45)) increased the risk of sepsis compared with normal vaginal delivery. Post-partum anaemia due to acute blood loss was associated with maternal sepsis (aOR 3.40 (95%CI: 2.59-4.47)).
Maternal obesity, obstetric interventions and post-partum anaemia due to acute blood loss increased the risk of diagnosed post-partum sepsis indicating that interventions in obstetric care should be considered carefully and anaemia should be treated if resources are available.
本研究旨在评估母体肥胖和/或产科干预是否与产后确诊的母体败血症有关。
这是一项回顾性观察性队列研究，纳入了 1997 年至 2012 年期间瑞典所有分娩（N=1,558,752）。通过《医疗出生登记册》和《国家患者登记册》中使用国际疾病分类（ICD-10）的 A40、A41 和 O85 代码来确定败血症（n=376）病例。参考人群为未感染的人群，因此，排除了任何其他感染诊断和/或产后八周内使用抗生素的女性。药物处方登记处提供了药物使用信息。将患有败血症的女性与非感染女性进行了比较，比较内容为产妇特征和产科干预措施。使用 Mantel-Haenszel 技术确定调整后的比值比（aOR）。对产妇年龄、产次和吸烟情况进行了调整。
与正常体重女性（2.0/10000）相比，肥胖女性（体重指数≥30）患败血症的风险增加了一倍（3.6/10000）（aOR 1.85（95%CI：1.37-2.48））。引产（aOR 1.44（95%CI：1.09-1.91））、剖宫产总体（aOR 3.06（95%CI：2.49-3.77））和择期剖宫产（aOR 2.41（95%CI：1.68-3.45））与正常阴道分娩相比，增加了败血症的风险。因急性失血导致的产后贫血与母体败血症相关（aOR 3.40（95%CI：2.59-4.47））。
母体肥胖、产科干预和因急性失血导致的产后贫血增加了产后确诊败血症的风险，这表明在产科护理中应谨慎考虑干预措施，如果有资源，应治疗贫血。
