Plain english summary
Introduction
Materials and methods
Systematic review
Search strategy
Review process
Data collection and synthesis
Expert consultation
Results
Systematic review
Name of organization proposing the definition, (year) | Definition | Studies referring to the definition | Guidelines referring to the definition |
---|---|---|---|
American College of Chest Physicians and the Society of Critical Care Medicine (1992) [17] |
Systemic inflammatory response syndrome (SIRS): Widespread inflammatory response to severe clinical insult defined by the presence of two or more of the following symptoms: ▸ Temperature >38 °C or <36 °C ▸ Heart rate >90/min ▸ Respiratory rate >20/min or PaCO2 < 32 mmHg ▸ White blood cells >12 × 10^9/dL or <4 × 10^9/dL or >10% immature forms
Sepsis: SIRS plus definitive evidence of infection
Severe sepsis: Sepsis with signs of organ dysfunction, hypoperfusion or hypotension
Septic shock: Sepsis with hypotension despite adequate fluid resuscitation | FLASOG 2013 [47] | |
International Classification of Diseases, Revision 10 (ICD-10) (1994) | A temperature rise above 100.4 F (38 °C) maintained over 24 h or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. | - | |
SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference 2001 (2003) [18] | Refers to American College of Chest Physicians and the Society of Critical Care Medicine (1992) definition as above with expanded list of criteria. | ||
The prevention and management of puerperal infections World Health Organization (WHO) (1992) [48] |
Puerperal sepsis is an infection of the genital tract occurring at any time between the rupture of membranes or labour and the 42nd day postpartum, in which, two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge and delay in the reduction of the size of the uterus | - | |
Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors WHO (2003) [50] | Infection can result in failure of the circulatory system to maintain adequate perfusion of the vital organs (shock). Suspect or anticipate shock if at least one of the following is present: fast weak pulse (110 per minute or more), low blood pressure (systolic less than 90 mmHg), sweatiness or cold clammy skin, rapid breathing (rate of 30 breaths or more), anxiousness, confusion or unconsciousness, scanty urine output (less than 30 ml per hour), other symptoms and signs of shock include: pallor (specially of inner eyelid, palms or around mouth). Septic abortion: an abortion complicated with infection. Sepsis may result from infection if organisms rise from the lower genital tract following either spontaneous or unsafe abortion. Symptoms and signs are: lower abdominal pain, rebound tenderness, tender uterus, prolonged bleeding, malaise, fever, foul-smelling vaginal discharge, purulent cervical discharge, cervical motion tenderness | - | - |
Midwifery education modules – Managing puerperal sepsis (WHO) (2008) [49] |
Puerperal sepsis is any bacterial infection of the genital tract which occurs after the birth of a baby. The following symptoms and signs occur in puerperal sepsis: fever (temperature of 38 °C or more), chills and general malaise, lower abdominal pain, tender uterus, subinvolution of the uterus, purulent, foul-smelling lochia. Symptoms and signs that may also be present: light vaginal bleeding, shock
Septic abortion: An abortion (loss of pregnancy during the first 22 weeks) that is followed by infection of the uterus and may spread throughout the genital tract causing fever and chills, foul-smelling vaginal discharge, pelvic pain and septicaemia | - | - |
System | Variable | Values or ranges (min - max) | References studies | References guidelines | Other signs | Other symptoms |
---|---|---|---|---|---|---|
Circulatory | Heart rate | >90/min (90–120/min) or > 2 SD above the normal value for age | Vasoplegia [34] | - | ||
Blood pressure | SBP <100 mmHg MAP <70 (65–70) mm Hg Decrease SBP >40 mmHg | - | ||||
Respiratory | Respiratory rate | >20/min (≤10 or ≥ 25/min) | ||||
Arterial blood gases | PaO2/FIO2 <40kPa | [43] | ||||
Central Nervous System | Altered mental status | Glasgow Coma scale <14/15 | - | [46] | ||
Hyperthermia | >38 °C (37.8–38.5 °C) | - | ||||
Hypothermia | <36 °C (35.5 °C – 36 °C) | - | - | |||
Renal | Lactate (mmol/L) | >1 (>1–4) | ||||
Kidney (Creat mg/dL) | >2 mg/dL or Raise > 0.5 mg/dL | [41] | ||||
Coagulation | Platelets (/ml) | <100,000 | - | |||
INR >1.5 or aPTT >60 s | ||||||
Digestive | Glucose (mmol/L) | >7.7 in the absence of DM | Mild intestinal tenderness without rebound tenderness | |||
Liver: total bilirubin (mmol/L) | >2 mg/dL >70 mmol/L | |||||
Skin | - | - | - | - | Decreased capillary refill, clammed or mottled skin Necrotizing fasciitis or myositis | - |
Genital | - | - | - | - | ||
Inflammatory | WBC(cells/μl) | >12000 (11000–16000) or <4000 or >10% immature forms | Preterm labour [25] | Breast redness, | ||
CRP | >7 mg/L >2SD | |||||
Procalcitonin | >2SD | |||||
Other | Culture | Positive | - | - | - | |
Fetal distress | - | - | - | Fetal distress secondary to maternal acidosis [45] | Reduced or absent fetal movements [45] |
Expert consultation
Consensus definition of maternal sepsis
“Maternal Sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or post-partum period”
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