title: Progression from severe sepsis in pregnancy to death: a UK population-based case-control analysis.
abstract: OBJECTIVE
  To identify factors associated with progression from pregnancy-associated severe sepsis to death in the UK.
  
  
  METHODS
  A population-based case-control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).
  
  
  METHODS
  All pregnancy care and death settings in UK hospitals.
  
  
  METHODS
  All non-influenza sepsis-related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non-influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358).
  
  
  METHODS
  Cases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals.
  
  
  METHODS
  Odds ratios for socio-demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.
  
  
  RESULTS
  Four factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64-141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23-5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62-7.89). Anaemia (aOR = 13.5, 95%CI 3.17-57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93-116.9) were the two most important factors driving the association between medical comorbidities and progression to death.
  
  
  CONCLUSIONS
  There must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis-related maternal deaths.
  
  
  CONCLUSIONS
  Medical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: O
authors.initials: O
authors.lastname: Mohamed-Ahmed
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Nair
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Acosta
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.affiliation: National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Knight
mesh_terms: D000740:Anemia / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy / Q000401:mortality*; D061665:Time-to-Treatment; D014478:Unemployment / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Maternal deaths; maternal sepsis; pregnancy; septic shock; severe acute maternal morbidity; severe sepsis