Sepsis in Pregnancy and the Puerperium: A Comparative Review of Major Guidelines
Notice bibliographique
Résumé
ABSTRACT Introduction Sepsis is one of the leading causes of maternal morbidity and mortality worldwide and a major public health concern, often associated with delayed diagnosis, suboptimal management, and poor perinatal outcomes. Objectives The aim of this study was to review and compare the most recently published influential guidelines on the prevention, diagnosis, and management of this complication during antenatal, intrapartum, and postpartum periods. Evidence Acquisition A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Society for Maternal-Fetal Medicine (SMFM), the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), the World Health Organization (WHO), and the Society of Obstetricians and Gynecologists of Canada (SOGC) on maternal and puerperal sepsis was carried out. Results RCOG, SMFM, and SOMANZ provide guidance on the diagnosis and management of sepsis in pregnancy and the puerperium, whereas the WHO and the SOGC refer only to the prevention of peripartum infections. There is a consensus among the reviewed guidelines that a detailed personal history, along with physical examination, cultures, laboratory tests, and appropriate imaging, is the mainstay in sepsis diagnosis; however, there are several discrepancies regarding the diagnostic criteria. On management, the necessity of broad-spectrum antibiotics administration, within the first hour from recognition, and early source control are underlined by RCOG, SMFM, and SOMANZ. Furthermore, adequate fluid resuscitation with crystalloids is required, targeting for a mean arterial pressure (MAP) >65 mm Hg, whereas persistent hypotension or tissue hypoperfusion should be managed with vasopressors. In addition, RCOG, SMFM, and SOMANZ agree that increased fetal surveillance is warranted in case of maternal sepsis and point out that the decision regarding the optimal time of delivery should be guided according to maternal and fetal condition. In case of preterm labor, the use of corticosteroids should be considered. Moreover, SOMANZ and SMFM recommend thromboprophylaxis for septic women. With regards to prevention of peripartum infections, the WHO recommends prophylactic antibiotic administration in case of cesarean delivery, group B Streptococcus colonization, manual placenta removal, third/fourth-degree perineal tears, and preterm premature rupture of membranes, while discouraging antibiotics in case of preterm labor with intact membranes, prelabor rupture of membranes at term, meconium-stained amniotic fluid, uncomplicated vaginal birth, episiotomy, and operative vaginal delivery. Finally, SOGC, although supporting antibiotic prophylaxis for cesarean delivery and third/fourth-degree perineal injury, does not recommend this intervention in case of manual placenta removal, postpartum dilatation, and curettage for retained products of conception, operative vaginal delivery, and cervical cerclage. Conclusions Sepsis remains a significant contributor of maternal morbidity and mortality with a constantly rising global incidence, despite the advances in diagnostic and therapeutic techniques. Thus, the development of consistent international practice protocols for the prevention, timely recognition, and effective management of this complication both in pregnancy and in the puerperium seems of paramount importance to safely guide clinical practice and subsequently improve perinatal outcomes. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the learner should be better able to identify the risk factors associated with maternal sepsis; evaluate the diagnostic and management procedures for sepsis in pregnancy and puerperium; and propose strategies for the prevention of peripartum infections.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,043 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,001 |
| Bibliométrie | 0,000 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».