Rate of sepsis during delivery on the rise

A new study in Anesthesia & Analgesia indicates that the incidence of severe and fatal sepsis during labor and delivery is on the rise in the United States.

Researchers from the University of Michigan Health System looked at data obtained from the Nationwide Inpatient Sample for the years 1998 to 2009. Severe sepsis was identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes.

Sepsis complicated 1:3333 (95% confidence interval [CI], 1:3151 – 1:3540) of the nearly 45 million deliveries reviewed. The rates of severe sepsis  and sepsis-related death were 1:10,823 (95% CI, 1:10,000 – 1:11,792) and 1:105,263, respectively (95% CI, 1:83,333 – 1:131,579). Overall frequency of sepsis remained stable (P=.95) during the period, but the risk of severe sepsis or sepsis-related death increased during the study period, (P<0.001) and (P=0.02), respectively.

Congestive heart failure, chronic liver disease, chronic renal disease, systemic lupus erythematous, and rescue cerclage placement were significant risk factors for developing sepsis. Advanced maternal age, black race, and Medicaid insurance also increased risk. Many of the women who developed sepsis during the study, however, had none of the known risk factors.

Researchers concluded that clinicians should carefully watch patients who exhibit one or more of the risk factors found in the study. Frequent development of severe sepsis in the absence of any risk factor, they concluded, indicates the need to develop tools to increase disease detection.

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