Lin L, Ren LW, Li XY, Sun W, Chen YH, Chen JS, Chen DJ. Evaluation of the etiology and risk factors for maternal sepsis: A single center study in Guangzhou, China. World J Clin Cases 2021; 9(26): 7704-7716 [PMID: 34621821 DOI: 10.12998/wjcc.v9.i26.7704]
Corresponding Author of This Article
Dun-Jin Chen, MD, Director, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao road, Liwan District, Guangzhou 510150, Guangdong Province, China. linlin19850000@163.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Lin Lin, Lu-Wen Ren, Xue-Yuan Li, Wen Sun, Yan-Hong Chen, Dun-Jin Chen, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
Lin Lin, Lu-Wen Ren, Xue-Yuan Li, Wen Sun, Yan-Hong Chen, Jing-Si Chen, Dun-Jin Chen, Key Laboratories for Major Obstetric Diseases of Guangdong Province, Guangzhou 510150, Guangdong Province, China
Jing-Si Chen, Department of Fetal Medicine and Prenatal Diagnosis, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
Author contributions: Lin L and Chen DJ conceived and designed the research; Lin L, Ren LW, Li XY and Chen YH collected data and conducted research; Lin L analyzed and interpreted data; Lin L wrote the initial paper; Lin L and Sun W revised the paper; Chen DJ and Chen JS had primary responsibility for final content; all authors read and approved the final manuscript.
Supported byNational Natural Science Foundation of China, No. 81830045 and No. 82071652.
Institutional review board statement: This study was approved by the ethics committee of the Third Affiliated Hospital of the Guangzhou Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent statement: Written informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets generated and analyzed during the present study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dun-Jin Chen, MD, Director, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao road, Liwan District, Guangzhou 510150, Guangdong Province, China. linlin19850000@163.com
Received: February 7, 2021 Peer-review started: February 7, 2021 First decision: May 11, 2021 Revised: May 19, 2021 Accepted: August 2, 2021 Article in press: August 2, 2021 Published online: September 16, 2021 Processing time: 214 Days and 18.3 Hours
Abstract
BACKGROUND
Maternal sepsis is a major cause of gestational morbidity and neonatal mortality worldwide and particularly in China.
AIM
To evaluate the etiology of maternal sepsis and further identify its risk factors.
METHODS
In this retrospective study, we evaluated 70698 obstetric patients who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 1, 2009 and June 30, 2018. Subjects were divided into sepsis group and non-sepsis group based on the incidence of sepsis. Data about medical history (surgical and obstetric history) and demographic information were collected. The Mann-Whitney U test was used to compare patient age, gestational age and duration of hospitalization between the two groups. Univariate and multivariate logistic regression models were used to analyze the etiology and the risk factors for maternal sepsis. Unadjusted and adjusted odds ratios (OR) are reported.
RESULTS
A total of 561 of 70698 obstetric patients were diagnosed with infection; of the infected patients, 492 had non-sepsis associated infection (87.7%), while 69 had sepsis (12.3%). The morbidity rate of maternal sepsis was 9.76/10000; the fatality rate in the sepsis group was 11.6% (8/69). Emergency admission (OR = 2.183) or transfer (OR = 2.870), irregular prenatal care (OR = 2.953), labor induction (OR = 4.665), cervical cerclage (OR = 14.214), first trimester (OR = 6.806) and second trimester (OR = 2.09) were significant risk factors for maternal sepsis.
CONCLUSION
Mode of admission, poor prenatal care, labor induction, cervical cerclage, first trimester and second trimester pregnancy were risk factors for maternal sepsis. Escherichia coli was the most common causative organism for maternal sepsis, and the uterus was the most common site of infection.
Core Tip: This study evaluated the etiology of maternal sepsis and identified its risk factors in Guangzhou, China. The results show that emergency admission or transfer, irregular prenatal care, labor induction, cervical cerclage, first trimester and second trimester were significant risk factors for maternal sepsis. The most common causative organism for maternal sepsis was Escherichia coli, and the most common site of infection was the uterus.
