Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

被引：82

作者：

Aman, Mohammad Iqbal ^{[1
]}

Noormal, Bashir ^{[1
]}

Diaz, Virginia ^{[1
]}

Espinoza, Marisa ^{[1
]}

Pasquale, Julia ^{[1
]}

Leroy, Charlotte ^{[1
]}

Roelens, Kristien ^{[1
]}

Vandenberghe, Griet ^{[1
]}

Agossou, M. Christian Urlyss ^{[1
]}

Keke, Sourou Goufodji ^{[1
]}

Aguemon, Christiane Tshabu ^{[1
]}

Apaza Peralta, Patricia Soledad ^{[1
]}

Conde Altamirano, Victor ^{[1
]}

Hernndez Munoz, Rosalinda ^{[1
]}

Cecatti, Jose Guilherme ^{[1
]}

Ribeiro-Do-Valle, Carolina C. ^{[1
]}

Batiene, Vincent ^{[1
]}

Cisse, Kadari ^{[1
]}

Ouedraogo, Henri Gautier ^{[1
]}

Kannitha, Cheang ^{[1
]}

Phirun, Lam ^{[1
]}

Rathavy, Tung ^{[1
]}

Simo, Elie ^{[1
]}

Tebeu, Pierre-Marie ^{[1
]}

Yakana, Emah Irene ^{[1
]}

Carvajal, Javier ^{[1
]}

Fernanda Escobar, Maria ^{[1
]}

Fernandez, Paula ^{[1
]}

Colmorn, Lotte Berdiin ^{[1
]}

Langhoff-Roos, Jens ^{[1
]}

Mereci, Wilson ^{[1
]}

Velez, Paola ^{[1
]}

Eldin, Yasser Salah ^{[1
]}

Sultan, Alaa ^{[1
]}

Abdosh, Abdulfetah Abdulkadir ^{[1
]}

Teklu, Alula M. ^{[1
]}

Kassa, Dawit Worku ^{[1
]}

Adanu, Richard ^{[1
]}

Govule, Philip ^{[1
]}

Lwanga, Charles Noora ^{[1
]}

Arriaga Romero, William Enrique ^{[1
]}

Flores Aceituno, Maria Guadalupe ^{[1
]}

Bustillo, Carolina ^{[1
]}

Castro, Rigoberto ^{[1
]}

Lara, Bredy ^{[1
]}

Kumar, Vijay ^{[1
]}

Suri, Vanita ^{[1
]}

Trikha, Sonia ^{[1
]}

Cetin, Irene ^{[1
]}

Donati, Serena ^{[1
]}

机构：

[1] WHO, Dept Sexual & Reprod Hlth & Res, CH-1211 Geneva 27, Switzerland

来源：

LANCET GLOBAL HEALTH | 2020年 / 8卷 / 05期

关键词：

SEPTIC SHOCK; MULTICOUNTRY SURVEY; SEVERE SEPSIS; MORTALITY;

D O I：

10.1016/S2214-109X(20)30109-1

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background Maternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management. Methods We did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups. Findings Between Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70.4 (95% CI 67.7-73.1) hospitalised women per 1000 livebirths had a maternal infection, and 10.9 (9.8-12.0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6.8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63.9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70.2%, n=1875), without marked differences across severity groups. Interpretation The frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices. Copyright (C) 2020

引用

页码：E661 / E671

页数：11

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