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Perinatal Outcomes Among Patients With Sepsis During Pregnancy

Source
JAMA Network Open
Year of publication
2021
Abstract
This cohort study compares rates of perinatal complications among pregnant individuals with and without antepartum sepsis hospitalization. Key Points: Question: Do patients who remain pregnant after discharge from an antepartum sepsis hospitalization have increased rates of perinatal complications? Findings: In this cohort study of 14 565 patients with nonanomalous, singleton pregnancies, a history of antepartum sepsis hospitalization was associated with higher odds of perinatal complications that are associated with placental dysfunction compared with no history of antepartum sepsis. After adjustment for possible confounders, including maternal age, parity, body mass index, and medical comorbidities, patients with antepartum sepsis had 2-fold higher odds of perinatal complications. Meaning: This study found that pregnancies with antepartum sepsis were associated with higher odds of complications that are associated with placental dysfunction, suggesting that increased antenatal surveillance may be warranted for these patients. Importance: Rates of maternal sepsis are increasing, and prior studies of maternal sepsis have focused on immediate maternal morbidity and mortality associated with sepsis during delivery admission. There are no data on pregnancy outcomes among individuals who recover from their infections prior to delivery. Objective: To describe perinatal outcomes among patients with antepartum sepsis who did not deliver during their infection hospitalization. Design, Setting, and Participants: This retrospective cohort study was conducted using data from August 1, 2012, to August 1, 2018, at an academic referral center in San Francisco, California. Included patients were all individuals with nonanomalous, singleton pregnancies who delivered after 20 weeks' gestation during the study period. Data were analyzed from March 2020 through March 2021. Exposures: Antepartum admission for infection with clinical concern for sepsis and hospital discharge prior to delivery. Main Outcomes and Measures: The primary outcome was a composite of perinatal outcomes associated with placental dysfunction and consisted of 1 or more of the following: fetal growth restriction, oligohydramnios, hypertensive disease of pregnancy, cesarean delivery for fetal indication, child who is small for gestational age, or stillbirth. Results: Among 14 565 patients with nonanomalous singleton pregnancies (mean [SD] age at delivery, 33.1 [5.2] years), 59 individuals (0.4%) were in the sepsis group and 14 506 individuals (99.6%) were in the nonsepsis group; 8533 individuals (59.0%) were nulliparous. Patients with sepsis, compared with patients in the reference group, were younger (mean [SD] age at delivery, 30.6 [5.7] years vs 33.1 [5.2] years; P <.001), were more likely to have pregestational diabetes (5 individuals [8.5%] vs 233 individuals [1.6%]; P =.003), and had higher mean (SD) pregestational body mass index scores (26.1 [6.1] vs 24.4 [5.9]; P =.03). In the sepsis group, the most common infections were urinary tract infections (24 patients [40.7%]) and pulmonary infections (22 patients [37.3%]). Among patients with sepsis, 5 individuals (8.5%) were admitted to the intensive care unit, the mean (SD) gestational age at infection was 24.6 (9.0) weeks, and the median (interquartile range) time from infection to delivery was 82 (42-147) days. Antepartum sepsis was associated with higher odds of placental dysfunction (21 patients [35.6%] vs 3450 patients [23.8%]; odds ratio, 1.77; 95% CI, 1.04-3.02; P =.04). On multivariable logistic regression analysis, antepartum sepsis was an independent factor associated with placental dysfunction (adjusted odds ratio, 1.88; 95% CI, 1.10-3.23; P =.02) after adjusting for possible confounders. Conclusions and Relevance: This study found that pregnancies complicated by antepartum sepsis were associated with higher odds of placental dysfunction. These findings suggest that increased antenatal surveillance should be considered for these patients.
Date added
08/10/2021
Created by
Sarah Thomas
Published by
Current Awareness Service for Health