title: Sepsis and maternal mortality.
abstract: OBJECTIVE
  Despite global progress towards reducing maternal mortality, sepsis remains a leading cause of preventable maternal death. This review focuses on current measurement challenges, trends, causes and efforts to curb maternal death from sepsis in high and low-income countries.
  
  
  RESULTS
  Under-reporting using routine registration data, compounded by misclassification and unreported deaths, results in significant underestimation of the burden of maternal death from sepsis. In the UK and the Netherlands the recent increase in maternal death from sepsis is mainly attributed to an increase in invasive group A streptococcal infections. Susceptibility to infection may be complicated by modulation of maternal immune response and increasing rates of risk factors such as caesarean section and obesity. Failure to recognize severity of infection is a major universal risk factor. Standardized Surviving Sepsis Campaign (SSC) recommendations for management of severe maternal sepsis are continuing to be implemented worldwide; however, outcomes differ according to models of intensive care resourcing and use.
  
  
  CONCLUSIONS
  The need for robust data with subsequent analyses is apparent. This will significantly increase our understanding of risk factors and their causal pathways, which are critical to informing effective treatment strategies in consideration of resource availability.
authors: National Perinatal Epidemiology Unit, University of Oxford, UK. colleen.acosta@npeu.ox.ac.uk
authors: Colleen D
authors: CD
authors: Acosta
authors: Marian
authors: M
authors: Knight
mesh_terms: D002423:Cause of Death; D002585:Cesarean Section / Q000009:adverse effects*; D019049:Developed Countries; D003906:Developing Countries; D004198:Disease Susceptibility; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D008429:Maternal Welfare; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D013297:Streptococcus pyogenes; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology