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Research article
Risk factors for postpartum sepsis: A nested case-control study
Sana Sheikh
Aga Khan University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7981-2957
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.
Methods: A case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC).
Results: Multivariable analysis revealed that 1-4 antenatal visits (95% CI 0.01 - 0.62) , 3 or more vaginal examinations (95% CI 1.21 - 3.65), home delivery (95% CI 1.72-50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93-20.23), lower abdominal pain (95% CI 1.15 - 3.42)) vaginal discharge (95% CI 2.97-20.21), SpO2 <93% (95% CI 4.80-37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80-0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis.
Conclusion: This study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.
Keywords
Sepsis, Risk factors, postpartum women, lower-middle income country
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CURRENT STATUS: Under Revision
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Posted 11 May, 2020
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Editorial decision: Minor revision
On 28 Apr, 2020
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On 26 Apr, 2020
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On 25 Apr, 2020
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On 25 Apr, 2020
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Received 14 Mar, 2020
Editorial decision: Major revision
On 14 Mar, 2020
Reviewer #4 agreed
On 12 Mar, 2020
Review #2 received
Received 04 Mar, 2020
Reviewer #3 agreed
On 03 Mar, 2020
Reviewer #2 agreed
On 17 Feb, 2020
Review #1 received
Received 14 Feb, 2020
Reviewer #1 agreed
On 04 Feb, 2020
Reviewers invited
Invitations sent on 02 Feb, 2020
Editor assigned
On 26 Dec, 2019
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On 25 Dec, 2019
Editor invited
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This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Risk factors for postpartum sepsis: A nested case-control study
Sana Sheikh
Aga Khan University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7981-2957
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 2
Posted 11 May, 2020
No community comments so far
Editorial decision: Minor revision
On 28 Apr, 2020
Editor assigned
On 26 Apr, 2020
Submission checks complete
On 25 Apr, 2020
Editor invited
On 25 Apr, 2020
No comments provided
Review #3 received
Received 14 Mar, 2020
Editorial decision: Major revision
On 14 Mar, 2020
Reviewer #4 agreed
On 12 Mar, 2020
Review #2 received
Received 04 Mar, 2020
Reviewer #3 agreed
On 03 Mar, 2020
Reviewer #2 agreed
On 17 Feb, 2020
Review #1 received
Received 14 Feb, 2020
Reviewer #1 agreed
On 04 Feb, 2020
Reviewers invited
Invitations sent on 02 Feb, 2020
Editor assigned
On 26 Dec, 2019
Submission checks complete
On 25 Dec, 2019
Editor invited
On 25 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women.
Methods: A case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC).
Results: Multivariable analysis revealed that 1-4 antenatal visits (95% CI 0.01 - 0.62) , 3 or more vaginal examinations (95% CI 1.21 - 3.65), home delivery (95% CI 1.72-50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93-20.23), lower abdominal pain (95% CI 1.15 - 3.42)) vaginal discharge (95% CI 2.97-20.21), SpO2 <93% (95% CI 4.80-37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80-0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis.
Conclusion: This study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.
Figure 1
Figure 2