Maternal mortality and severe morbidity from sepsis in the Netherlands.
OBJECTIVE
To assess incidence and risk factors of maternal mortality and severe morbidity from sepsis in the Netherlands.


METHODS
A nationwide confidential enquiry into maternal mortality from 1993 to 2006 and severe maternal morbidity from 2004 to 2006.


METHODS
All 98 Dutch maternity units in the Netherlands.


METHODS
All pregnant women in the Netherlands from 1993 to 2006.


METHODS
All reported cases of maternal death from sepsis during 1993-2006 were reported to the Maternal Mortality Committee. Cases of severe maternal morbidity from sepsis from 2004 to 2006 were collected in a nationwide design. Main outcome measures. Incidence, case fatality rates, and possible risk factors.


RESULTS
The maternal mortality ratio from direct maternal mortality from sepsis was 0.73 per 100,000 live births (20/2,742,265). The incidence of severe maternal morbidity from sepsis was 21 per 100,000 deliveries (78/371,021), of which 79% was admitted to the intensive care unit. High age, multiple pregnancies, and the use of artificial reproduction techniques were significant risk factors for developing sepsis in univariate analysis. The overall case fatality rate for sepsis during 2004-2006 was 7.7% (6/78). Group A streptococcal infection was in 42.9% (9/21), the cause of direct maternal mortality from sepsis (1993-2006). In 31.8% (14/44), Group A streptococcal infection was the cause of obstetric morbidity from sepsis (2004-2006).


CONCLUSIONS
With a case fatality rate of 7.7%, sepsis is a life threatening condition for women during pregnancy, childbirth, and puerperium.
Department of Obstetrics & Gynaecology, Medical Centre Haaglanden, Hague, The Netherlands. hannah.kramer@gmail.com
Hannah M C
HM
Kramer
Joke M
JM
Schutte
Joost J
JJ
Zwart
Nico W E
NW
Schuitemaker
Eric A P
EA
Steegers
Jos
J
van Roosmalen
D005260:Female; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D013290:Streptococcal Infections / Q000453:epidemiology*; D013297:Streptococcus pyogenes