title: Maternal sepsis: a Scottish population-based case-control study.
abstract: OBJECTIVE
  To describe the risk of maternal sepsis associated with obesity and other understudied risk factors such as operative vaginal delivery.
  
  
  METHODS
  Population-based, case-control study.
  
  
  METHODS
  North NHS region of Scotland.
  
  
  METHODS
  All cases of pregnant, intrapartum and postpartum women with International Classification of Disease-9 codes for sepsis or severe sepsis recorded in the Aberdeen Maternal and Neonatal Databank (AMND) from 1986 to 2009. Four controls per case selected from the AMND were frequency matched on year-of-delivery.
  
  
  METHODS
  Cases and controls were compared; significant variables from univariable regression were adjusted in a multivariable logistic regression model.
  
  
  METHODS
  Dependent variables were uncomplicated sepsis or severe ('near-miss') sepsis. Independent variables were demographic, medical and clinical delivery characteristics. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) are reported.
  
  
  RESULTS
  Controlling for mode of delivery and demographic and clinical factors, obese women had twice the odds of uncomplicated sepsis (OR 2.12; 95% CI 1.14-3.89) compared with women of normal weight. Age <25 years (OR 5.15; 95% CI 2.43-10.90) and operative vaginal delivery (OR 2.20; 95% CI 1.02-4.87) were also significant predictors of sepsis. Known risk factors for maternal sepsis were also significant in this study (OR for uncomplicated and severe sepsis respectively): multiparity (OR 6.29, 12.04), anaemia (OR 3.43, 18.49), labour induction (OR 3.92 severe only), caesarean section (OR 3.23, 13.35), and preterm birth (OR 2.46 uncomplicated only).
  
  
  CONCLUSIONS
  Obesity, operative vaginal delivery and age <25 years are significant risk factors for sepsis and should be considered in clinical obstetric care.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK. colleen.acosta@npeu.ox.ac.uk
authors.forename: C D
authors.initials: CD
authors.lastname: Acosta
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharya
authors.forename: D
authors.initials: D
authors.lastname: Tuffnell
authors.forename: J J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.forename: M
authors.initials: M
authors.lastname: Knight
mesh_terms: D000031:Abortion, Septic / Q000208:ethnology; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D044466:Asian People / Q000706:statistics & numerical data; D016470:Bacteremia / Q000208:ethnology* / Q000401:mortality / Q000517:prevention & control; D044383:Black People / Q000706:statistics & numerical data; D015992:Body Mass Index; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D005260:Female; D006771:Hospitals, Maternity; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D008428:Maternal Mortality / Q000208:ethnology; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000208:ethnology* / Q000401:mortality / Q000517:prevention & control; D015995:Prevalence; D011645:Puerperal Infection / Q000208:ethnology; D012307:Risk Factors; D012494:Sampling Studies; D012606:Scotland / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data