Ali Amaan, Lamont Ronnie F
St Bartholomew's and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London, E1 2AT, UK.
Department of Gynecology and Obstetrics, University of Southern Denmark, Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, Kløvervænget 10, 5000 Odense C, Denmark.
F1000Res. 2019 Aug 30;8. doi: 10.12688/f1000research.18736.1. eCollection 2019.
Maternal sepsis accounts for 11% of all maternal deaths worldwide. It is the third most common direct cause of maternal death and is a major contributor to other common causes of maternal death, such as haemorrhage and thromboembolism. This review addresses important topics, including the epidemiology, risk factors, prevention, diagnosis, care bundles and management of maternal sepsis, including antibiotic treatment, and critical care interventions such as extracorporeal membrane oxygenation. Preventative measures that have had an impact on maternal sepsis as well as future research directions are also covered in this review. Case studies of maternal sepsis which highlight key learning points relevant to all clinicians involved in the management of obstetric patients will also be presented. Although, historically, maternal death from sepsis was considered to be a problem for low-income countries, severe obstetric morbidity and maternal death from sepsis are increasing in high-income countries. The global burden of maternal sepsis and the obstetric-related and patient-related risk factors and the likely sources are presented. Recent changes in definition and nomenclature are outlined, and challenges in diagnosis and identification are discussed. Following maternal sepsis, early diagnosis and early intervention are critical to save lives and prevent long-term adverse sequelae. Dogma surrounding critical care interventions in pregnancy is being challenged, and future research is warranted to maximise therapeutic options available for maternal septic shock.
孕产妇败血症占全球孕产妇死亡总数的11%。它是孕产妇死亡的第三大常见直接原因，也是孕产妇死亡其他常见原因（如出血和血栓栓塞）的主要促成因素。本综述探讨了重要主题，包括孕产妇败血症的流行病学、危险因素、预防、诊断、护理套餐及管理，包括抗生素治疗以及体外膜肺氧合等重症监护干预措施。本综述还涵盖了对孕产妇败血症产生影响的预防措施以及未来的研究方向。还将展示孕产妇败血症的案例研究，突出与参与产科患者管理的所有临床医生相关的关键学习要点。虽然从历史上看，败血症导致的孕产妇死亡被认为是低收入国家的问题，但在高收入国家，严重的产科发病率和败血症导致的孕产妇死亡正在增加。介绍了孕产妇败血症的全球负担以及产科相关和患者相关的危险因素及可能的来源。概述了定义和术语的最新变化，并讨论了诊断和识别方面的挑战。孕产妇败血症发生后，早期诊断和早期干预对于挽救生命和预防长期不良后遗症至关重要。围绕孕期重症监护干预措施的教条正在受到挑战，有必要进行未来研究以最大限度地增加可用于孕产妇感染性休克的治疗选择。
