title: Maternal physiologic parameters in relationship to systemic inflammatory response syndrome criteria: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To establish the normal maternal range in healthy pregnant women for each component of the systemic inflammatory response syndrome (SIRS) criteria and compare these ranges with existing SIRS criteria.
  
  
  METHODS
  PubMed, Embase, and ClinicalTrials.gov databases were searched to identify studies of healthy parturients from the first trimester through 12 weeks postpartum that reported maternal temperature, respiratory rate, PaCO2, heart rate, white blood cell count data, or a combination of these.
  
  
  METHODS
  Data were extracted from studies providing maternal values for components of SIRS criteria. The mean, standard deviation, and two standard deviations from the mean for all criteria parameters published in the literature were reported.
  
  
  RESULTS
  Eighty-seven studies met inclusion criteria and included 8,834 patients and 15,237 data points: temperature (10 studies and 2,367 patients), respiratory rate (nine studies and 312 patients), PaCO2 (12 studies and 441 patients), heart rate (39 studies and 1,374 patients), and white blood cell count (23 studies and 4,553 patients). Overlap with SIRS criteria occurred in healthy pregnant women during the second trimester, third trimester, and labor for each of the SIRS criteria except temperature. Every mean value for PaCO2 during pregnancy (and up to 48 hours postpartum) was below 32 mm Hg. Two standard deviations above the mean for temperature, respiratory rate, and heart rate were 38.1°C, 25 breaths per minute, and 107 beats per minute, respectively.
  
  
  CONCLUSIONS
  Current SIRS criteria often overlap with normal physiologic parameters during pregnancy and the immediate postpartum period; thus, alternative criteria must be developed to diagnose maternal sepsis.
authors.affiliation: Department of Anesthesiology, Division of Obstetric Anesthesiology, and the Taubman Health Sciences Library, University of Michigan Health System, and the Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, and the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; and the Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Bauer
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Bauer
authors.forename: Baskar
authors.initials: B
authors.lastname: Rajala
authors.forename: Mark P
authors.initials: MP
authors.lastname: MacEachern
authors.forename: Linda S
authors.initials: LS
authors.lastname: Polley
authors.forename: David
authors.initials: D
authors.lastname: Childers
authors.forename: David M
authors.initials: DM
authors.lastname: Aronoff
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008429:Maternal Welfare; D062072:Patient Acuity; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011264:Pregnancy Trimesters / Q000502:physiology*; D011644:Puerperal Disorders / Q000175:diagnosis*; D012016:Reference Values; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*; D055986:Vital Signs / Q000502:physiology