Maternal infections in healthcare settings

A clearer picture of global influence

New research from A global study of maternal sepsis (GLOSS), a major WHO / HRP initiative, shows that infection has a much greater impact on global and maternal mortality than previously thought.

GLOSS results, Posted in Lancet Global Health, are the first to provide data on the incidence of maternal infections and
sepsis during pregnancy and after pregnancy in a large number of healthcare settings around the world.

About 11 women per 1,000 live births had an infection that resulted in or contributed to what is known as a severe maternal outcome – whether it died, or almost died – during their hospitalization.

There is an urgent need to improve the management of this life-threatening risk faced by all pregnant women and recently pregnant women, wherever they are in the world.

What is maternal sepsis and how does it lead to maternal death?

Maternal sepsis is a life-threatening condition that occurs when the body’s response to infection causes damage to its own tissues and organs during pregnancy, childbirth, after miscarriage or after childbirth.

The latest global estimates place sepsis due to obstetric infections as the third most common cause of maternal mortality. However, it only includes infections as a direct result of pregnancy, such as endometritis or post-caesarean wound infections.

Several
previous studies include post-abortion infections. Neither do they deal with indirect infections like respiratory and meningitis, which are exacerbated by pregnancy but are not directly caused.

Better understanding of maternal infection

The GLOSS was a massive WHO-led data collection effort, accompanied by ‘STOP SEPSIS! ‘ increase awareness with healthcare providers.

The study collected data on women who were admitted for suspected or confirmed infections during pregnancy or after pregnancy during one week in 2017. More than 2,800 women in 52 countries participated in the study.

GLOSS included health care facilities for women during pregnancy, childbirth or at the end of pregnancy, as well as facilities without maternity service but in which women could be hospitalized during or after pregnancy, and information on infections
usually not recorded as maternal sepsis, including post-abortion and indirect infections.

The result is a fuller understanding of the incidence and impact of maternal infections in healthcare settings.

GLOSS draws attention not only to the wider range of risks faced by pregnant women, but also to the long period of time at which they are exposed.

Putting global numbers on maternal infection and sepsis

Overall, about 70 pregnant women, or more recently pregnant women per 1,000 live births, have been found to have maternal infection that needs hospital management.

Through the study, 11 women with direct or indirect infection per 1,000 live births developed a serious maternal outcome, but in low- and middle-income countries up to 15 women per 1,000 births were affected.

Infections were the major cause of most of the deaths recorded during the study, primarily post-abortion infection and indirect infection. Infections were also present in about a third of deaths attributed to other causes, such as postpartum
bleeding.

This indicates that the contribution of infection to global maternal mortality and morbidity may be greater than suggested by current reports of maternal sepsis mortality.

Prevention, recognition and treatment of maternal infection and sepsis

Some of the most common maternal infections found in the study, such as urinary tract infections, post-caesarean section, and post-abortion, are mostly preventable and treatable.

The GLOSS results suggest that current levels of monitoring and clinical care in healthcare settings are insufficient to effectively prevent, recognize and treat maternal infection levels.

For example, a third of women in the study did not report a complete set of vital signs on the day their infection was suspected or diagnosed. Delays in antimicrobial therapy were common.

GLOSS also shows significant differences between countries, with the highest burden in low- and middle-income countries, compared to high-income countries.

This may reflect the impact of broad health determinants in different countries. Overcrowding Challenges, Limited Access to Water and Sanitation, and Restrictions on Safe Birth by Qualified Birth Trainees May Decrease Health Care Ability
providers to manage the incidence and outcome of maternal infections.

An opportunity to apply evidence-based practice

GLOSS provides healthcare providers, policymakers and the general public with the opportunity: yes mobilize around this data improve evidence-based practice and save lives.

WHO has produced numerous resources that can support timely action to prevent, diagnose and treat maternal infection, as well as activities such as upcoming SAVE LIVES: Clean your hands campaign
May 5, which celebrates the central role of nurses and midwives in clean healthcare.

In addition, the WHO will publish a global report on the epidemiology of sepsis around the 73rd World Health Assembly (WHA) in May, in accordance with guidelines in
2017
WHA resolution on improving the prevention, diagnosis and clinical treatment of sepsis.

Understanding why and how infection affects women is critical to equipping healthcare providers with life-saving knowledge and enabling health systems to reduce global mortality and maternal mortality.

Related publications

WHO Recommendations for the Prevention and Treatment of Maternal Peripheral Infections

WHO Clinical Practice Handbook for Safe Abortion

Global guidelines for the prevention of surgical site infection

WHO statement on maternal sepsis

World Health Assembly resolution on improving the prevention, diagnosis and clinical treatment of sepsis

Health topics

Antimicrobial resistance

Prevention and control of infection

Sanitary water hygiene

Other links

A global study of maternal sepsis

SAVE LIVES: Clean your hands on May 5, 2020