{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T03:03:53Z","timestamp":1764817433572,"version":"3.46.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Maternal sepsis is a leading cause of preventable maternal morbidity and mortality in the United States. We assessed the implementation of a standardized early\u2010goal\u2010directed sepsis care bundle on maternal and neonatal outcomes. This bundle was activated by a set of vital sign criteria in combination with providers\u2019 concern for infection and included immediate rapid response team evaluation and standardized orders for fluid resuscitation, antibiotics, and labs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was performed at a single tertiary care center between January 1, 2012 and December 31, 2018. Individuals were included if they were pregnant or within 6 weeks of delivery with a singleton gestation and had a recorded temperature measurement of &gt;100.4\u00b0F (38\u00b0C) or &lt;96.8\u00b0F (36\u00b0C) in addition to a heart rate &gt;100 beats\/min or a respiratory rate &gt;20 breaths\/min within 30 min of the documented temperature during an inpatient stay or triage visit. Groups were categorized as pre\u2010implementation (January 2012\u2013September 2016) and post\u2010implementation (October 2016\u2013December 2018) of the \u201ccode sepsis\u201d protocol. The primary outcome was a composite of maternal sepsis\u2010related outcomes: (1) intensive care unit admission, (2) acute renal failure (defined as a creatinine\u00a0&gt;\u00a01.1\u00a0mg\/dL), and (3) maternal death. Multiple secondary outcomes were analyzed. Outcomes were compared across groups using generalized estimating equation models and adjusted for significant characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 5368 pregnancies met criteria for inclusion: 56% pre\u2010implementation and 44% post\u2010implementation. Post\u2010implementation, 126 code sepsis protocols were activated after providers had clinical concern for infection. An identified infection diagnosis was found in 12.2% of the post\u2010implementation and 12.1% of the pre\u2010implementation group with urinary tract infection being the most common. The primary outcome occurred in 7.0% of the pre\u2010implementation group and 4.6% of the post\u2010implementation group (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.52\u20130.83; adjusted OR [aOR], 0.64; 95% CI, 0.48\u20130.83). Stratified analysis by temperature &gt;100.4\u00b0F (38\u00b0C) or temperature &lt;96.8\u00b0F (36\u00b0C) revealed an association when criteria were met with hypothermia (OR, 0.55; 95% CI, 0.39\u20130.78; aOR, 0.48; 95% CI, 0.33\u20130.70), but not hyperthermia. When activated, the protocol had\u00a0&gt;92% adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Implementation of an early\u2010goal\u2010directed sepsis care pathway led to improved maternal outcomes in an obstetric population with a 36% reduction in the primary outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70129","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T12:40:16Z","timestamp":1760791216000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of the implementation of an obstetric sepsis protocol on maternal and neonatal outcomes"],"prefix":"10.1002","volume":"1","author":[{"given":"Ashley E.","family":"Shea","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Center for Women's Reproductive Health at the University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina T.","family":"Blanchard","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health Department of Obstetrics and Gynecology University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth B.","family":"Ausbeck","sequence":"additional","affiliation":[{"name":"Novant Health Novant Health Maternal\u2010Fetal Medicine  Charlotte North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rubymel J.","family":"Knupp","sequence":"additional","affiliation":[{"name":"Regional Obstetric Consultants Pediatrix Medical Group  Jacksonville Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr.","given":"J. Michael","family":"Straughn","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology Department of Obstetrics and Gynecology Center for Women's Reproductive Health at the University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeff M.","family":"Szychowski","sequence":"additional","affiliation":[{"name":"Department of Biostatistics School of Public Health University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akila","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Center for Women's Reproductive Health at the University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Women's Reproductive Health Department of Obstetrics and Gynecology University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian M.","family":"Casey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences West Virginia University  Morgantown West Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan T.","family":"Tita","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Center for Women's Reproductive Health at the University of Alabama at Birmingham  Birmingham Alabama USA"},{"name":"Center for Women's Reproductive Health Department of Obstetrics and Gynecology University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.9818"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.02.002"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6818e1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000423"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2022.03.003"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.739221"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2011.411"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010021\u201006506\u2010y"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2017.04.005"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000438"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000297"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq\u20102018\u2010000355"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004471"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.01.216"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.101.6.1644"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31827e83af"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181cb0cdc"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000259463.33848.3D"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010021\u201003921\u20103"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajo.12646"}],"container-title":["Pregnancy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T02:29:17Z","timestamp":1764815357000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pmf2.70129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,18]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/pmf2.70129"],"URL":"https:\/\/doi.org\/10.1002\/pmf2.70129","archive":["Portico"],"relation":{},"ISSN":["2997-9684","2997-9684"],"issn-type":[{"type":"print","value":"2997-9684"},{"type":"electronic","value":"2997-9684"}],"subject":[],"published":{"date-parts":[[2025,10,18]]},"article-number":"e70129"}}