Maternal sepsis: epidemiology, etiology and outcome.
OBJECTIVE
Sepsis is a major cause of maternal death worldwide. Little is known on the incidence of severe maternal morbidity related to sepsis. In this review, we focus on new findings concerning epidemiology, etiology and outcome of maternal sepsis in low-income as well as high-income countries.


RESULTS
It is estimated that puerperal sepsis causes at least 75,000 maternal deaths every year, mostly in low-income countries. Studies from high-income countries report incidence of maternal morbidity due to sepsis of 0.1-0.6 per 1000 deliveries. The causative microorganisms are generally polymicrobial with beta-haemolytic streptococci group A (GAS) often being the cause of severe cases of puerperal fever. The single most important risk factor for postpartum infection seems to be caesarean section, and prophylactic antibiotics during the procedure substantially reduce the infection risk. Improvements in service provision as promoted through the Surviving Sepsis Campaign can reduce the overall risk of mortality and morbidity from maternal sepsis in high-income as well as in low-income countries.


CONCLUSIONS
Maternal sepsis is an infrequent, but important complication of pregnancy, childbirth and puerperium, resulting in significant maternal morbidity and mortality worldwide. Improved outcome is possible through improved service provision.
van Dillen
Jeroen
J
Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, The Netherlands. j.j.m.van_roosmalen@lumc.nl
Zwart
Joost
J
Schutte
Joke
J
van Roosmalen
Jos
J
D005260:Female; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D011645:Puerperal Infection / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome