Necrotizing Fasciitis Associated with Pregnancy: a Population-Based Cohort Study

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Necrotizing fasciitis (NF) is a rare but severe complication during pregnancy.
• Population-level data on pregnancy-associated NF (PANF) epidemiology, clinical features, and outcomes were previously lacking.

Purpose of the Study:

• To investigate the epidemiology, clinical characteristics, resource utilization, and outcomes of pregnancy-associated necrotizing fasciitis (PANF).
• To analyze trends in PANF incidence and patient comorbidities over a decade.

Main Methods:

• Retrospective, population-based cohort study using the Texas Inpatient Public Use Data File (2001-2010).
• Identification of hospitalizations using ICD-9-CM code 728.86 for NF.
• Calculation of incidence using total estimated pregnancies (TEP) derived from state health statistics.

Main Results:

• 148 PANF hospitalizations identified among over 4 million pregnancy-associated hospitalizations.
• PANF incidence increased nearly 3.5-fold (1.1 to 3.8 per 100,000 TEP-years) from 2001-2002 to 2009-2010.
• Most PANF events (82.4%) occurred postpartum, with rising chronic comorbidities (0% to 31.7%) and organ failure (9.1% to 31.7%) over the study period.

Conclusions:

• The incidence of PANF has significantly increased over the past decade, particularly in the postpartum period.
• Increasing chronic illness and severity of illness were observed in PANF patients.
• Despite increased severity, hospital mortality for PANF was lower compared to the general population, warranting further investigation into causative factors.