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

2020; Elsevier BV; Volume: 8; Issue: 5 Linguagem: Inglês

10.1016/s2214-109x(20)30109-1

2572-116X

Mercedes Bonet, Vanessa Brizuela, Edgardo Ábalos, Cristina Cuesta, Adama Baguiya, Mónica Chamillard, Bukola Fawole, Marian Knight, Séni Kouanda, Pisake Lumbiganon, Ashraf Nabhan, Rūta Jolanta Nadišauskienė, Abdulfetah Abdulkadir, Richard MK Adanu, Mohammad Iqbal Aman, William Enrique Arriaga Romero, Bouchra Assarag, Kitty W.M. Bloemenkamp, Aigul Boobekova, Mihaela A. Budianu, V. Cararach, Rigoberto Castro, Sylvia Cebekhulu, José Guilherme Cecatti, Lotte Berdiin Colmorn, Ala Curteanu, Serena Donati, Hla Mya Thway Einda, Yasser Salah El Deen, Faysal El Kak, Mohamed A. El‐Sheikh, María Fernanda Escobar-Vidarte, Marisa Espinoza, María Ester Estrada, Luis Gadama, Sourou Goufodji, Saima Hamid, Rosalinda Hernández Muñoz, Nazarea Herrera Maldonado, Kapila Jayaratne, Saule Kabylova, Alexandra Krištúfková, Vijay Kumar, D. Lissauer, Wilson Mereci, Meilė Minkauskienė, Philippe Marc Moreira, Stephen Munjanja, Nafissa Osman, Henri Gautier Ouédraogo, Aquilino M. Pérez, Julia Pasquale, Lucian Puşcaşiu, Zahida Qureshi, Zenaida Dy Recidoro, Carolina C. Ribeiro‐do‐Valle, Dhammica Rowel, Hamadoun Sangho, Amir Babu Shrestha, Thitiporn Siriwachirachai, Pierre Marie Tebeu, Khaing Nwe Tin, Dinh Anh Tuan, Tung Rathavy, Griet Vandenberghe, Buyanjargal Yadamsuren, Dilrabo Yunusova, Nelly Zavaleta, Bashir Noormal, Virginia Díaz, C. Leroy, Kristien Roelens, Christian Agossou, Christiane Tshabu Aguèmon, Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Vincent Batiene, Kadari Cissé, Kannitha Cheang, Phirun Lam, Elie Simo, Emah Irene Yakana, Javier Carvajal, Paula Fernández, Jens Langhoff‐Roos, Paola Vélez, Alaa Sultan, Alula M. Teklu, Dawit Worku, Philip Govule, Charles Noora Lwanga, María Guadalupe Flores Aceituno, Carolina Bustillo, Bredy Lara, Vanita Suri, Sonia Trikha, Irene Cetin, C. Personeni, Guldana Baimussanova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Raisa Asylbasheva, Damira Seksenbaeva, Saad Eddine Itani, Sabina Abou Malham, Diana Ramašauskaitė, Owen Chikhwaza, Eddie Malunga, Haoua Dembelé, Hamadoun Sangho, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Juan I. Islas Castañeda, Tatiana Cauaus, Victor Petrov, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Zara Jaze, Arlete Mariano, Thae Maung Maung, Tara Gurung, Sangeeta Shrestha, Marcus J. Rijken, Thomas van den Akker, María Esther Estrada, Néstor J. Pavón Gómez, Olubukola Adeponle Adesina, Chris Aimakhu, Rizwana Chaudhri, Maseer Khan, María del Pilar Huatuco Hernández, Maria Lu Andal, Carolina Paula Martin, Léopold Diouf, Dembo Guirassy, Miroslav Borovský, Ladislav Kováč, Laura Cornelissen, Priya Soma‐Pillay, Marta López, María José Vidal Benedé, Hemali Jayakody, Mohamed A. El‐Sheikh, Wisal Nabag, Sara Omer, Victoria Tsoy, Urunbish Uzakova, Thumwadee Tangsiriwatthana, Catherine Dunlop, Jhon Roman, Gerardo Vitureira, Luong Ngoc Truong, Nghiem Thi Xuan Hanh, Mugove Gerald Madziyire, Thulani Magwali, Linda Bartlett, Fernando Bellíssimo-Rodrigues, Shevin T. Jacob, Sadia Shakoor, Khalid Yunis, Liana Campodónico, Hugo Gamerro, Daniel Giordano, Fernando Althabe, A Metin Gülmezoglu, João Paulo Souza,

Maternal and Perinatal Health Interventions

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.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.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.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.UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.