1
|
Moraes MMD, Santos AAPD, Leitão JDDSDS, Farias KFFDL, Silva NADS, Tavares NVDS, Melo KORCD, Comassetto I. Adherence to sepsis protocol in a high-risk maternity reference center. Rev Bras Enferm 2024; 77:e20230453. [PMID: 39258607 PMCID: PMC11382675 DOI: 10.1590/0034-7167-2023-0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/23/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVE To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center. METHODS This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies. RESULTS Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases. CONCLUSION The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.
Collapse
|
2
|
Gad A, Alkhdr M, Terkawi R, Alsharif H, Ibrahim M, Amin R, Algibali E, Chandra P, Hamed M, Petkar HM, Bayoumi MAA. Associations between maternal bacteremia during the peripartum period and early-onset neonatal sepsis: a retrospective cohort study. BMC Pediatr 2024; 24:526. [PMID: 39143544 PMCID: PMC11325601 DOI: 10.1186/s12887-024-04980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Early-onset neonatal sepsis (EONS) significantly impacts neonatal morbidity and mortality, with maternal bacteremia during the peripartum period being a potential risk factor. This study aims to explore the association between peripartum maternal bacteremia and EONS. METHODS A retrospective cohort study at the Women's Wellness and Research Center in Doha, Qatar (2015-2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS. RESULTS Among the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 - 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 - 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 - 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 - 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 - 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 - 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 - 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 - 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates. CONCLUSION This study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.
Collapse
Affiliation(s)
- Ashraf Gad
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
- Pediatric Department, Weill Cornell Medicine, Doha, Qatar.
| | - Mahmoud Alkhdr
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rayan Terkawi
- Division of Pediatric Nephrology, University of Miami, Miami, FL, USA
| | - Hafsa Alsharif
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Marwa Ibrahim
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Rasha Amin
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Elmunzir Algibali
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Manal Hamed
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Hawabibee Mahir Petkar
- Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad A A Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
3
|
Abera BT, Teka H, Gebre D, Gebremariam T, Berhe E, Gidey H, Amare B, Kidanemariam R, Gebru MA, Tesfay F, Zelelow YB, Yemane A, Gebru F, Tekle A, Tadesse H, Yahya M, Tadesse Y, Abraha HE, Alemayehu M, Ebrahim MM. Maternal sepsis and factors associated with poor maternal outcomes in a tertiary hospital in Tigray, Ethiopia: a retrospective chart review. BMC Infect Dis 2024; 24:170. [PMID: 38326776 PMCID: PMC10848478 DOI: 10.1186/s12879-024-09075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. METHODS A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. RESULTS Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. CONCLUSIONS This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options.
Collapse
Affiliation(s)
- Bisrat Tesfay Abera
- Department of Internal Medicine, School of Medicine, Mekelle University, Box: 1871, Mekelle, Tigray, Ethiopia.
| | - Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Daniel Gebre
- Department of Midwifery, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, School of Medicine, Mekelle University, Box: 1871, Mekelle, Tigray, Ethiopia
| | - Hagos Gidey
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Birhane Amare
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Rahel Kidanemariam
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Marta Abrha Gebru
- Department of Internal Medicine, School of Medicine, Mekelle University, Box: 1871, Mekelle, Tigray, Ethiopia
| | - Fireweyni Tesfay
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Fanus Gebru
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ashenafi Tekle
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mohammedtahir Yahya
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ytbarek Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Department of Biostatistics, School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
- University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Mussie Alemayehu
- Department of Reproductive Health, School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
| | | |
Collapse
|
4
|
Mohn SF, Reimer R, Mar N, Katelieva A, Paquette V, Albert AYK, Roberts A, Tilley P, McClymont E, Ting J, Boucoiran I, Elwood C. Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre. Int J Gynaecol Obstet 2024; 164:786-792. [PMID: 37658607 DOI: 10.1002/ijgo.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. METHODS Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018. RESULTS The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first- and third-generation cephalosporins, respectively. Clinical sources of infection included intra-amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%). CONCLUSION Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first-line antibiotics.
Collapse
Affiliation(s)
- Sarah F Mohn
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Renee Reimer
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Nicole Mar
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Vanessa Paquette
- BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | | | - Ashley Roberts
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Peter Tilley
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Elisabeth McClymont
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Ting
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Isabelle Boucoiran
- Mother and Child Infectious Disease Centre, CHU Sainte, Justine, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology and School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Chelsea Elwood
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Neonatal Healthcare-Associated Conjunctivitis: A Descriptive Study from Saudi Arabia. Medicina (B Aires) 2022; 58:medicina58101448. [PMID: 36295608 PMCID: PMC9608085 DOI: 10.3390/medicina58101448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Healthcare-associated conjunctivitis (HAC) has been associated with serious ophthalmological complications in neonates, including blindness. This three-year retrospective, descriptive study was conducted between 2019 and 2021 to determine the most common bacteria associated with neonatal HAC at a tertiary-care hospital in Saudi Arabia. The inclusion criteria were defined based on the centers for disease control and prevention (CDC) guidelines for the diagnosis of neonatal HAC. When HAC was clinically suspected, conjunctival swabs were obtained from neonates and sent to the microbiology lab following standard protocols. A univariate analysis was conducted on the included samples. A total of 79 cases met our inclusion criteria and were retrospectively studied. A descriptive analysis showed that Pseudomonas aeruginosa was the leading cause of HAC, with 25% (20 cases), followed by Escherichia coli and Klebsiella pneumonia (11.5% for each). About 9% of the analyzed cases were positive for Staphylococcus aureus. Orogastric feeding was the most commonly (94%) associated factor with HAC, followed by respiratory distress syndrome (RDS) and preterm birth, which were found in 70% and 64% of the cases, respectively. To conclude, HAC is an alarming healthcare problem, and bacteria, including Gram-negative bacteria, are common causes. Thus, physician awareness, effective communication with microbiologists, and the implementation of infection control recommendations, including hand hygiene, could minimize this problem and avoid the serious complications of HAC.
Collapse
|
6
|
Zhong X, Lin R, Zhang W, Huang S, Luo Y, Wang D. Epidemiology and clinical features of maternal sepsis: A retrospective study of whole pregnancy period. Medicine (Baltimore) 2022; 101:e30599. [PMID: 36221418 PMCID: PMC9543042 DOI: 10.1097/md.0000000000030599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/16/2022] [Indexed: 01/05/2023] Open
Abstract
Maternal sepsis results in poor outcomes such as fetal or maternal death. The incidence and mortality rates of maternal sepsis vary in different places because of differences in economic development, race and medical conditions. Identifying the clinical features and determining possible mechanisms for avoiding morbidity and preventing poor outcomes would benefit committed patients. Therefore, this was an epidemiological study at a maternity transfer center in Southeast China that aimed to identify local disease features of maternal sepsis. To investigate the incidence and risk factors associated with maternal sepsis and its progression to severe sepsis in a large population-based birth cohort. This local epidemiological study was conducted in at a tertiary care center in Guangzhou, China, from 2015 to 2019. A total of 74,969 pregnant women experiencing childbirth were included in this study; Of these, 74 patients with maternal sepsis were diagnosed according to the sepsis criterion, and 118 patients without sepsis in the same period were selected randomly as the control group to study possible reasons for postpartum sepsis. This retrospective analysis covered the entire period from the first trimester to puerperium. Clinical data were collected using the hospital's electronic medical record system. Multivariate logistic regression was used to analyze risk factors for maternal sepsis. The incidences of maternal sepsis, the maternal mortality, and the fetal mortality were 0.099%, 0.004%, and 0.007%, respectively. Septic shock was associated with a higher severity of illness. All poor outcomes (maternal or fetal death) occurred during pregnancy. Postpartum sepsis had the longest onset period, and was associated with premature rupture of fetal membranes and preeclampsia. Sepsis is an important cause of both maternal and fetal mortality. Herein, we describe an epidemiological study that evaluated the incidence, development, and prognosis of local maternal sepsis. Furthermore, the characteristics of maternal sepsis are likely due to unknown pathological mechanisms, and patients would benefit from identifying more effective treatments for maternal sepsis.
Collapse
Affiliation(s)
- Xuan Zhong
- Medical Intensive Care Unit, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Rongfeng Lin
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wenni Zhang
- Medical Intensive Care Unit, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Shan Huang
- Medical Intensive Care Unit, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Yiping Luo
- Medical Intensive Care Unit, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Ding Wang
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
7
|
Li H, Dong M, Xie W, Qi W, Teng F, Li H, Yan Y, Wang C, Han C, Xue F. Mixed Vaginitis in the Third Trimester of Pregnancy Is Associated With Adverse Pregnancy Outcomes: A Cross-Sectional Study. Front Cell Infect Microbiol 2022; 12:798738. [PMID: 35419297 PMCID: PMC8995747 DOI: 10.3389/fcimb.2022.798738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Mixed vaginitis is a complex vaginal dysbiosis that differs from single vaginitis. Vaginitis in the third trimester may lead to adverse maternal and neonatal outcomes. The clinical characteristics, microbiological characteristics, and adverse pregnancy outcomes of mixed vaginitis in late pregnancy are worth studying. Therefore, this study investigated the clinical and microbiological characteristics of vaginitis and adverse pregnancy outcomes of patients with mixed vaginitis. We studied 1,674 women in late pregnancy who attended the Tianjin Medical University General Hospital from November, 2019 to October, 2021. We administered standardized questionnaires, performed vaginal examination and sampling plus microscope examinations, and assessed follow-up pregnancy outcomes. We cultured the vaginal discharge of the patients with mixed vaginitis to isolate pathogens and performed antimicrobial susceptibility tests of the isolated pathogens. For the patients with peripartum infection, we collected a sample to isolate pathogens. Among the 1,674 women, 66 (3.9%) had mixed vaginitis. The independent risk factor for mixed vaginitis in late pregnancy was a history of vaginitis during early and middle pregnancy (OR = 5.637, 95% CI: 3.314–9.580). The signs of vaginal erythema (63.6% vs. 42.0%), yellow discharge (81.8% vs. 59.6%), and malodor (31.8% vs. 18.8%) (P <0.05) were significantly higher in patients with mixed vaginitis than in patients with single vaginitis. Bacterial isolates of the vaginal secretions of patients with mixed bacterial vaginitis were mainly the pathogens of aerobic vaginitis and bacterial vaginosis, such as Gardnerella vaginalis, Streptococcus anginosus, and Staphylococcus epidermidis. Pathogen isolation of the vaginal secretions of patients with mixed fungus and bacteria vaginitis mainly included Candida albicans, followed by S. anginosus, Enterococcus faecalis, Staphylococcus hemolyticus, Staphylococcus aureus, Streptococcus agalactiae and Staphylococcus simulans. Women with mixed vaginitis had an increased incidence and risk of peripartum infections (6.1% vs. 1.4%, P <0.05; OR = 3.985, 95% CI:1.214–13.079). Escherichia coli is the main pathogen that causes peripartum infection. Mixed vaginitis in late pregnancy is characterized by a severe and complex phenotype, complex vaginal dysbiosis, and a long course of vaginal dysbiosis. This can lead to an increased incidence and risk of peripartum infection. Therefore, more attention should be paid to patients with mixed vaginitis in the third trimester of pregnancy.
Collapse
Affiliation(s)
- Huanrong Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Mengting Dong
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjuan Xie
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenhui Qi
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Fei Teng
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ye Yan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Cha Han
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Cha Han, ; Fengxia Xue,
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenic, Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Cha Han, ; Fengxia Xue,
| |
Collapse
|
8
|
Baguiya A, Bonet M, Cecatti JG, Brizuela V, Curteanu A, Minkauskiene M, Jayaratne K, Ribeiro-do-Valle CC, Budianu MA, Souza JP, Kouanda S. Perinatal outcomes among births to women with infection during pregnancy. Arch Dis Child 2021; 106:946-953. [PMID: 34475107 PMCID: PMC8461398 DOI: 10.1136/archdischild-2021-321865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC). DESIGN We conducted a 1-week inception hospital-based cohort study. SETTING The study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017. PATIENTS We included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up. MAIN OUTCOME MEASURES Perinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death). RESULTS 1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother's infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death. CONCLUSIONS Overall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.
Collapse
Affiliation(s)
- Adama Baguiya
- Kaya Health and Demographic Surveillance System (Kaya-HDSS), Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - José Guilherme Cecatti
- Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Campinas, SP, Brazil
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ala Curteanu
- Department of Perinatology, Mother and Child Institute, Chisinau, Moldova
| | - Meile Minkauskiene
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kapila Jayaratne
- Maternal & Child Morbidity & Mortality Surveillance Unit, Family Health Bureau, Colombo, Sri Lanka
| | | | - Mihaela-Alexandra Budianu
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Mureș, Romania
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Séni Kouanda
- Ecole docotorale ED2ST, Saint Thomas d'Aquin University (USTA), Ouagadougou, Burkina Faso,Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | | | | |
Collapse
|
9
|
|