Retrospective Study
Copyright ©The Author(s) 2021.
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)
CardiovascularMAP ≥ 70 mmHgMAP < 70 mmHgDopamine < 5.0 Dopamine = 5.1–15.0Dopamine > 15.0
Or dobutamine (any dose)1Or adrenaline ≤ 0.1Or adrenaline> 0.1
Or noradrenaline ≤ 0.11Or noradrenaline >0.11
Central nerve system
Glasgow1513–1410–126–9< 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
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 = -0.6040.546
Migrant population
Yes10521 (30.4)84 (17.1)χ2 = 7.1010.008
No45648 (69.4)408 (82.9)
Employment status
No10531 (44.9)74 (15.0)χ2 = 35.529< 0.001
Yes45638 (55.1)418 (85.0)
Marital status
Married52457 (82.6)467 (94.9)χ2 = 12.954< 0.001
Single or divorced3712 (17.4)25 (5.1)
Ethnicity
Han55366 (95.7)487 (99.0)χ2 = 4.7780.063
Minorities83 (4.3)55 (1.0)
Education level
> 12 yr15611 (15.9)145 (29.5)
7-12 yr36548 (69.6)317 (64.4)χ2 = 9.6560.008
≤ 6 yr4010 (14.5)30 (6.1)
Insurance status
Yes19314 (20.3)179 (36.4)χ2 = 6.9440.008
Self-pay36855 (85.1)313 (63.6)
Type of admission
Outpatient25115 (21.7)236 (48.0)
ER7510 (14.5)65 (13.2)χ2 = 18.369< 0.001
Transfer 23541 (63.8)191 (38.8)
Prenatal care
Regular31020 (29.0)290 (58.9)χ2 = 22.257< 0.001
Irregular12523 (33.3)102 (20.7)
Lack of prenatal care 12626 (37.3)100 (20.3)
Gestational age32.00 (26.15, 38.00)29.20 (21.05, 38.35)32.00 (27.23, 38.00)Z = -2.2960.022
Gestational age
< 14185 (7.2)13 (2.6)
14–27+614427 (39.1)117(23.8) χ2 = 11.6520.003
≥ 2839937 (53.6)362 (73.6)
Premature rupture of membranes
No42251 (73.9)371(75.4)χ2 = 0.0720.788
Yes13918 (26.1)121 (24.6)
Surgical history
No40642 (60.9)364 (74.0)χ2 = 5.2050.023
Yes15527 (39.1)128 (26.0)
Fever
Antepartum27238 (55.1)234 (47.6)
Intrapartum312 (2.9)29 (5.9)χ2 = 55.986< 0.001
Postpartum11129 (42.0)82 (16.7)
No1470 (0)147 (29.9)
Gestational complications
Multiple pregnancy
No49463 (91.3)431 (87.6)χ2 = 0.7890.374
Yes676 (8.7)61 (12.4)
Gestational diabetic or diabetes
No49865 (94.2)433 (88.0) χ2 = 2.3290.127
Yes634 (5.8)59 (12.0)
Gestational hypertension
No47965 (94.2)414 (84.1)χ2 = 4.9040.027
Yes824 (5.8)78 (15.9)
Placenta previa or accrete
No51354 (78.3)459 (93.3)χ2 = 17.476< 0.001
Yes4815 (21.7)33 (6.7)
Thyroid disease
No53965 (94.2)474 (96.3)χ2 = 0.2770.391
Yes224 (5.8)18 (3.7)
Table 3 Risk factors for maternal sepsis
OR95%CI
P value

Lowest
Highest
Immigrant population1.3800.6982.7290.355
Single/divorced2.3470.9585.7480.062
Ethnic groups2.8880.50416.5560.234
Education level0.540
> 12 yrControl
7–12 yr0.9610.4262.1680.924
≤ 6 yr1.6150.5234.9850.405
Employment0.2120.1120.399< 0.001
Insured0.8890.4211.8770.758
Mode of admission0.025
OutpatientControl
ER2.1830.8345.7150.112
Transfer2.8701.3366.1670.007
Prenatal care0.029
RegularControl
Irregular2.9531.3246.5860.008
No prenatal care1.9500.8854.2950.098
Manual removal of placenta 2.5180.33319.0590.371
Labor induction4.6651.98410.966< 0.001
Cervical cerclage14.2142.20191.8080.005
Placenta previa or accrete 2.1580.9315.0030.073
Gestational age0.002
≥ 28Control
14–27+62.0901.0943.9950.026
< 146.8062.02122.9190.002
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 accrete63 (4.7)3 (0.6)χ2 = 7.9910.027
Labor induction5715 (21.7)42 (8.2)χ2 = 11.5550.001
Amniocentesis123 (4.3)9 (1.8)χ2 = 0.8280.363
Cervical cerclage73 (4.3)4 (0.8)χ2 = 6.1360.043
Cesarean section729 (13.0)63(12.8)χ2 = 0.0030.956
Number of pathogenic bacterium
06819 (27.5)49 (10.0)
134534 (49.3)311 (63.2)χ2 = 23.873< 0.001
2539 (13.0)44 (8.9)
≥ 3164 (5.8)12 (2.4)
Without pathogen detection793 (4.3)76 (15.4)
Category of pathogenic bacterium
Escherichia coli10125 (36.2)76 (15.4)χ2 = 17.709< 0.001
Staphylococcus328 (11.6)24 (4.9)χ2 = 3.9030.048
GAS93 (4.3)6 (1.2)χ2 = 2.0320.154
GBS101 (1.4)9 (1.8)χ2 = 0.0001
Enterococcus faecalis294 (5.8)25 (5.1)χ2 = 0.0001
Site of infection
Other or unknown152 (2.9)13 (2.6)
Uterine21732 (46.4)185 (37.6)
Respiratory13312 (17.4)121 (24.6)χ2 = 24.395< 0.001
Urinary tract17613 (18.8)163 (33.1)
Placental complications2010 (14.5)10 (2.0)
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
Hysterectomy2113 (18.8)8 (1.6)χ2 = 45.106< 0.001
Intubation4431 (44.9)13 (2.6)χ2 = 149.697< 0.001
Transfusion5639 (56.5)17 (3.5)χ2 = 189.643< 0.001
Hemofiltration or plasma exchange1716 (23.2)1 (0.2)χ2 = 101.117< 0.001
ICU admission10858 (84.1)50 (10.2)χ2 = 212.564< 0.001
Death88 (11.59)0χ2 = 57.869< 0.001
Duration of hospitalization8.0 (5.0, 11.0)11.0 (8.0, 14.5)8.0 (5.0, 10.0)z = -4.971< 0.001
Perinatal outcomes
Survive30937 (53.6)272 (55.3)
Death7626 (37.7)50 (10.2)χ2 = 46.753< 0.001
Not yet delivered1766 (8.7)170 (34.6)