{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T22:14:44Z","timestamp":1789769684229,"version":"4.0.1"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T00:00:00Z","timestamp":1559692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009660","name":"London School of Hygiene and Tropical Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009660","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the association between the use of invasive treatments for postpartum hemorrhage and the risk of sepsis and severe sepsis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Secondary data analysis of the <jats:styled-content style=\"fixed-case\">WOMAN<\/jats:styled-content> randomized controlled trial, including 20\u00a0060 women with postpartum hemorrhage in 21 countries. Logistic regression with random effects was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cumulative incidence was 1.8% for sepsis and 0.5% for severe sepsis. All\u2010cause mortality was 40.4% in women with severe sepsis versus 2.2% for women without. After adjusting for bleeding severity and other confounders, intrauterine tamponade, hysterectomy, and laparotomy increased the risk of sepsis (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.77 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.21\u20132.59], <jats:italic>P<\/jats:italic>=0.004; <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.97 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.49\u20132.65], <jats:italic>P<\/jats:italic>&lt;0.001; and <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 6.63 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4.29\u201310.24], <jats:italic>P<\/jats:italic>&lt;0.001, respectively) and severe sepsis (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 2.60 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.47\u20134.59], <jats:italic>P<\/jats:italic>=0.002; <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 1.97 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.83\u20132.46], <jats:italic>P<\/jats:italic>=0.033; and <jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 5.35 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 2.61\u201310.98], <jats:italic>P<\/jats:italic>&lt;0.001, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this secondary data analysis, certain invasive treatments for postpartum hemorrhage appear to increase the risk of sepsis. Further research is needed to confirm this finding and investigate the role of prophylactic antibiotics during these procedures. The harms and benefits of such interventions must be carefully weighed, both in treatment guidelines and during individual patient management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration: ISRCTN76912190<\/jats:title><\/jats:sec>","DOI":"10.1002\/ijgo.12860","type":"journal-article","created":{"date-parts":[[2019,5,13]],"date-time":"2019-05-13T07:40:47Z","timestamp":1557733247000},"page":"231-237","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Secondary analysis of the <scp>WOMAN<\/scp> trial to explore the risk of sepsis after invasive treatments for postpartum hemorrhage"],"prefix":"10.1002","volume":"146","author":[{"given":"Laura","family":"Cornelissen","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine  London UK"},{"name":"Department of Obstetrics and Gynecology UZ Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susannah","family":"Woodd","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haleema","family":"Shakur\u2010Still","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bukola","family":"Fawole","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology National Institute of Maternal and Child Health College of Medicine University of Ibadan  Ibadan Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shehla","family":"Noor","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Ayub Medical and Teaching Institute  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saturday","family":"Etuk","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology College of Medical Sciences University of Calabar  Calabar Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adesina Lawrence","family":"Akintan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mother and Child Hospital  Akure Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rizwana","family":"Chaudhri","sequence":"additional","affiliation":[{"name":"Department Obstetrics and Gynecology Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Roberts","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00838-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-017-0321-6"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12892"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e328339257c"},{"key":"e_1_2_8_8_1","volume-title":"Recommendations for prevention and treatment of peripartum infections","author":"World Health Organization","year":"2015"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.3109\/01443615.2012.731453"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01859.x"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12710"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067175"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002351"},{"key":"e_1_2_8_14_1","first-page":"e106","article-title":"Prevention and management of postpartum hemorrhage. 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