Lancet Glob Health. 2020 May;8(5):e661-e671. doi: 10.1016/S2214-109X(20)30109-1.
Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.
We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.
Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7-73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8-12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups.
The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.
产妇感染是导致孕产妇死亡和严重产妇发病率的一个重要原因。我们报告了世卫组织全球产妇败血症研究的主要发现，该研究旨在根据产妇特征和结局评估卫生保健机构中产妇感染的频率，并评估早期识别和管理核心实践的覆盖范围。
我们在 52 个低收入和中等收入国家（LMIC）和高收入国家（HIC）的 713 个提供产科、助产或堕胎护理的卫生保健机构或因妊娠、分娩、产后或堕胎并发症而可住院的机构中进行了基于设施的前瞻性为期一周的发病队列研究。我们从医院记录中获得了所有疑似或确诊感染的住院孕妇或最近分娩的孕妇的数据。我们计算了每 1000 例活产中感染和感染相关严重产妇结局（即死亡或接近死亡）的比例，以及按国家收入组划分的院内病死率，以及一系列识别和管理感染严重程度的核心实践的覆盖范围。
在 2017 年 11 月 28 日至 12 月 4 日期间，对 2965 名符合条件的妇女进行了评估，其中 2850 名疑似或确诊感染的孕妇或最近分娩的孕妇被纳入研究。每 1000 例活产中有 70.4（95%CI 67.7-73.1）名产妇发生感染，每 1000 例活产中有 10.9（9.8-12.0）名产妇发生感染相关（潜在或促成原因）严重产妇结局。感染率最高的是 LMIC，最低的是 HIC。感染相关的产妇死亡率为严重产妇结局的 6.8%，其中低收入国家的比例最高。感染相关的产妇死亡占院内死亡的一半以上。大约三分之二（63.9%，n=1821）的妇女记录了完整的生命体征，或在疑似或诊断感染的当天接受了抗生素治疗（n=1875，70.2%），各组间无明显差异。
在卫生保健机构中需要管理的产妇感染的频率很高。我们的研究结果表明，直接（产科）和间接（非产科）感染对产妇总死亡人数的影响大于先前的估计。迫切需要改善早期识别，以及通过实施有效的循证实践，在卫生保健机构中及时管理感染妇女。
联合国开发计划署/联合国人口基金/联合国儿童基金会/世界卫生组织/世界银行人类生殖研究、发展和研究培训特别方案、世卫组织、默克关爱母亲和美国国际开发署。
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