Evaluation of the etiology and risk factors for maternal sepsis: A single center study in Guangzhou, China

doi:10.12998/wjcc.v9.i26.7704

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World Journal of Clinical Cases

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2307-8960

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Sep 16, 2021; 9(26): 7704-7716
Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7704

Table 1 The sequential organ failure assessment[1]

	Score
System	0	1	2	3	4
Breath
PaO2/FiO2, mmHg (kPa)	≥ 400 (53.3)	< 400 (53.3)	< 300 (40.0)	< 200 (26.7) need breathing support	< 100 (13.3)
Clotting factor
Platelets	≥ 150	< 150	< 100	< 50	< 20
Liver
Bilirubin mg/dL (µmol/L)	< 1.2 (20)	1.2–1.9 (20–32)	2.0–5.9 (33–101)	6.0–11.9 (102–204)	> 12.0 (204)
Cardiovascular	MAP ≥ 70 mmHg	MAP < 70 mmHg	Dopamine < 5.0	Dopamine = 5.1–15.0	Dopamine > 15.0
			Or dobutamine (any dose)¹	Or adrenaline ≤ 0.1	Or adrenaline> 0.1
				Or noradrenaline ≤ 0.1¹	Or noradrenaline >0.1¹
Central nerve system
Glasgow	15	13–14	10–12	6–9	< 6
Kidney
Creatinine mg/dL (µmol/L)	< 1.2 (110)	1.2–1.9 (110–170)	2.0–3.4 (171–299)	3.5–4.9 (300–440)	> 5.0 (440)
Urine output mL/d				< 500	< 200

¹The dosage of catecholamine is µg/kg/min for at least one hour. MAP: Mean arterial pressure.

Table 2 Comparisons of demographic and clinical characteristics between the sepsis group and the non-sepsis group, n (%)

	Infected maternal patients, n = 561	Sepsis group, n = 69	Non-sepsis group, n = 492	Statistical value	P value
Demographic information
Age [yr, (IQR)]	29 (25, 33)	28 (24, 33)	29 (26, 33)	z = -0.604	0.546
Migrant population
Yes	105	21 (30.4)	84 (17.1)	χ² = 7.101	0.008
No	456	48 (69.4)	408 (82.9)
Employment status
No	105	31 (44.9)	74 (15.0)	χ² = 35.529	< 0.001
Yes	456	38 (55.1)	418 (85.0)
Marital status
Married	524	57 (82.6)	467 (94.9)	χ² = 12.954	< 0.001
Single or divorced	37	12 (17.4)	25 (5.1)
Ethnicity
Han	553	66 (95.7)	487 (99.0)	χ² = 4.778	0.063
Minorities	8	3 (4.3)	55 (1.0)
Education level
> 12 yr	156	11 (15.9)	145 (29.5)
7-12 yr	365	48 (69.6)	317 (64.4)	χ² = 9.656	0.008
≤ 6 yr	40	10 (14.5)	30 (6.1)
Insurance status
Yes	193	14 (20.3)	179 (36.4)	χ² = 6.944	0.008
Self-pay	368	55 (85.1)	313 (63.6)
Type of admission
Outpatient	251	15 (21.7)	236 (48.0)
ER	75	10 (14.5)	65 (13.2)	χ² = 18.369	< 0.001
Transfer	235	41 (63.8)	191 (38.8)
Prenatal care
Regular	310	20 (29.0)	290 (58.9)	χ² = 22.257	< 0.001
Irregular	125	23 (33.3)	102 (20.7)
Lack of prenatal care	126	26 (37.3)	100 (20.3)
Gestational age	32.00 (26.15, 38.00)	29.20 (21.05, 38.35)	32.00 (27.23, 38.00)	Z = -2.296	0.022
Gestational age
< 14	18	5 (7.2)	13 (2.6)
14–27⁺⁶	144	27 (39.1)	117(23.8)	χ² = 11.652	0.003
≥ 28	399	37 (53.6)	362 (73.6)
Premature rupture of membranes
No	422	51 (73.9)	371(75.4)	χ² = 0.072	0.788
Yes	139	18 (26.1)	121 (24.6)
Surgical history
No	406	42 (60.9)	364 (74.0)	χ² = 5.205	0.023
Yes	155	27 (39.1)	128 (26.0)
Fever
Antepartum	272	38 (55.1)	234 (47.6)
Intrapartum	31	2 (2.9)	29 (5.9)	χ² = 55.986	< 0.001
Postpartum	111	29 (42.0)	82 (16.7)
No	147	0 (0)	147 (29.9)
Gestational complications
Multiple pregnancy
No	494	63 (91.3)	431 (87.6)	χ² = 0.789	0.374
Yes	67	6 (8.7)	61 (12.4)
Gestational diabetic or diabetes
No	498	65 (94.2)	433 (88.0)	χ² = 2.329	0.127
Yes	63	4 (5.8)	59 (12.0)
Gestational hypertension
No	479	65 (94.2)	414 (84.1)	χ² = 4.904	0.027
Yes	82	4 (5.8)	78 (15.9)
Placenta previa or accrete
No	513	54 (78.3)	459 (93.3)	χ² = 17.476	< 0.001
Yes	48	15 (21.7)	33 (6.7)
Thyroid disease
No	539	65 (94.2)	474 (96.3)	χ² = 0.277	0.391
Yes	22	4 (5.8)	18 (3.7)

IQR: Interquartile range; ER; Emergency.

Table 3 Risk factors for maternal sepsis

	OR	95%CI		P value
	OR	Lowest	Highest	P value
Immigrant population	1.380	0.698	2.729	0.355
Single/divorced	2.347	0.958	5.748	0.062
Ethnic groups	2.888	0.504	16.556	0.234
Education level				0.540
> 12 yr	Control
7–12 yr	0.961	0.426	2.168	0.924
≤ 6 yr	1.615	0.523	4.985	0.405
Employment	0.212	0.112	0.399	< 0.001
Insured	0.889	0.421	1.877	0.758
Mode of admission				0.025
Outpatient	Control
ER	2.183	0.834	5.715	0.112
Transfer	2.870	1.336	6.167	0.007
Prenatal care				0.029
Regular	Control
Irregular	2.953	1.324	6.586	0.008
No prenatal care	1.950	0.885	4.295	0.098
Manual removal of placenta	2.518	0.333	19.059	0.371
Labor induction	4.665	1.984	10.966	< 0.001
Cervical cerclage	14.214	2.201	91.808	0.005
Placenta previa or accrete	2.158	0.931	5.003	0.073
Gestational age				0.002
≥ 28	Control
14–27⁺⁶	2.090	1.094	3.995	0.026
< 14	6.806	2.021	22.919	0.002

CI: Confidence interval; ER: Emergency; OR: Odds ratio.

Table 4 Analysis of the causes of maternal sepsis, n (%)

	Infected maternal patients, n = 561	Sepsis group, n = 69	Non-sepsis group, n = 492	Statistical value	P value
Surgical history
Placenta previa or accrete	6	3 (4.7)	3 (0.6)	χ² = 7.991	0.027
Labor induction	57	15 (21.7)	42 (8.2)	χ² = 11.555	0.001
Amniocentesis	12	3 (4.3)	9 (1.8)	χ² = 0.828	0.363
Cervical cerclage	7	3 (4.3)	4 (0.8)	χ² = 6.136	0.043
Cesarean section	72	9 (13.0)	63(12.8)	χ² = 0.003	0.956
Number of pathogenic bacterium
0	68	19 (27.5)	49 (10.0)
1	345	34 (49.3)	311 (63.2)	χ² = 23.873	< 0.001
2	53	9 (13.0)	44 (8.9)
≥ 3	16	4 (5.8)	12 (2.4)
Without pathogen detection	79	3 (4.3)	76 (15.4)
Category of pathogenic bacterium
Escherichia coli	101	25 (36.2)	76 (15.4)	χ² = 17.709	< 0.001
Staphylococcus	32	8 (11.6)	24 (4.9)	χ² = 3.903	0.048
GAS	9	3 (4.3)	6 (1.2)	χ²= 2.032	0.154
GBS	10	1 (1.4)	9 (1.8)	χ² = 0.000	1
Enterococcus faecalis	29	4 (5.8)	25 (5.1)	χ² = 0.000	1
Site of infection
Other or unknown	15	2 (2.9)	13 (2.6)
Uterine	217	32 (46.4)	185 (37.6)
Respiratory	133	12 (17.4)	121 (24.6)	χ² = 24.395	< 0.001
Urinary tract	176	13 (18.8)	163 (33.1)
Placental complications	20	10 (14.5)	10 (2.0)

GAS: Group A Staphylococcus; GBS: Group B Staphylococcus.

Table 5 Comparison of maternal and perinatal outcomes between the sepsis group and non-sepsis group, n (%)

	Infected maternal patients, n = 561	Sepsis group, n = 69	Non-sepsis group, n = 492	Statistical value	P value
Maternal outcomes
Hysterectomy	21	13 (18.8)	8 (1.6)	χ² = 45.106	< 0.001
Intubation	44	31 (44.9)	13 (2.6)	χ² = 149.697	< 0.001
Transfusion	56	39 (56.5)	17 (3.5)	χ² = 189.643	< 0.001
Hemofiltration or plasma exchange	17	16 (23.2)	1 (0.2)	χ² = 101.117	< 0.001
ICU admission	108	58 (84.1)	50 (10.2)	χ² = 212.564	< 0.001
Death	8	8 (11.59)	0	χ² = 57.869	< 0.001
Duration of hospitalization	8.0 (5.0, 11.0)	11.0 (8.0, 14.5)	8.0 (5.0, 10.0)	z = -4.971	< 0.001
Perinatal outcomes
Survive	309	37 (53.6)	272 (55.3)
Death	76	26 (37.7)	50 (10.2)	χ²= 46.753	< 0.001
Not yet delivered	176	6 (8.7)	170 (34.6)

ICU: Intensive care unit.

Citation: 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
URL: https://www.wjgnet.com/2307-8960/full/v9/i26/7704.htm
DOI: https://dx.doi.org/10.12998/wjcc.v9.i26.7704