Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Maternal sepsis is a major global cause of death and severe illness, ranking as the second leading cause of direct maternal mortality in Italy.
• Delayed recognition and treatment initiation are primary drivers of adverse outcomes associated with maternal sepsis.
• Understanding incidence, risk factors, and outcomes is vital for improving maternal and neonatal care.

Purpose of the Study:

• To determine the incidence of maternal sepsis in Italy.
• To identify associated risk factors, management strategies, and perinatal outcomes.
• To inform targeted interventions for sepsis prevention and management.

Main Methods:

• A prospective, population-based study involving six Italian regions (48.2% of national births) from November 2017 to October 2019.
• Included maternal sepsis cases from 22 weeks' gestation to 42 days postpartum, with a nested case-control study for postpartum sepsis.
• Maternal sepsis diagnosis required suspected/confirmed infection plus organ failure signs.

Main Results:

• The incidence rate of maternal sepsis was 5.5 per 10,000 maternities (95% CI 4.80-6.28).
• Predominant infection sources were genital, respiratory, and urinary tracts, often caused by E. coli and polymicrobial infections.
• Vascular or indwelling bladder catheters significantly increased postpartum sepsis risk (nine-fold).

Conclusions:

• While no maternal deaths occurred in this cohort, one-fourth of women experienced severe adverse events, and 28.3% required intensive care.
• 1.8% of newborns died, highlighting the critical impact on perinatal outcomes.
• Promoting targeted interventions to raise awareness of maternal sepsis, its risk factors, and management is essential.