{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:40:41Z","timestamp":1788493241875,"version":"build-2803163510"},"reference-count":31,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["RP-PG-0608-10038"],"award-info":[{"award-number":["RP-PG-0608-10038"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,7,14]]},"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe the incidence, characteristics and risk factors for critical care admission with severe maternal sepsis in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>National cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>198 critical care units in the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>646 pregnant and recently pregnant women who had severe sepsis within the first 24\u2005hours of admission in 2008\u20132010.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Septic shock, mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of all maternal critical care admissions, 14.4% (n=646) had severe sepsis; 10.6% (n=474) had septic shock. The absolute risk of maternal critical care admission with severe sepsis was 4.1\/10\u2005000 maternities. Pneumonia\/respiratory infection (irrespective of the H1N1 pandemic influenza strain) and genital tract infection were the most common sources of sepsis (40% and 24%, respectively). We identified a significant gradient in the risk of severe maternal sepsis associated with increasing deprivation (RR=6.5; 95% CI 4.9 to 8.5 most deprived compared with most affluent women). The absolute risk of mortality was 1.8\/100\u2005000 maternities. The most common source of infection among women who died was pneumonia\/respiratory infection (41%). Known risk factors for morbidity supported by this study were: younger age, multiple gestation birth and caesarean section. Significant risk factors for mortality in unadjusted analysis were: age \u226535\u2005years (unadjusted OR (uOR)=3.5; 95% CI 1.1 to 10.6), \u22653 organ system dysfunctions (uOR=12.7; 95% CI 2.9 to 55.1), respiratory dysfunction (uOR=6.5; 95% CI1.9 to 21.6), renal dysfunction (uOR=5.6; 95% CI 2.3 to 13.4) and haematological dysfunction (uOR=6.5; 95% CI 2.9 to 14.6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study suggests a need to improve timely recognition of severe respiratory tract and genital tract infection in the obstetric population. The social gradient associated with the risk of severe sepsis morbidity and mortality raises important questions regarding maternal health service provision and usage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-012323","type":"journal-article","created":{"date-parts":[[2016,8,23]],"date-time":"2016-08-23T22:49:33Z","timestamp":1471992573000},"page":"e012323","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":82,"title":["Maternal morbidity and mortality from severe sepsis: a national cohort study"],"prefix":"10.1136","volume":"6","author":[{"given":"Colleen D","family":"Acosta","sequence":"first","affiliation":[{"name":"National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Harrison","sequence":"additional","affiliation":[{"name":"Intensive Care National Audit & Research Centre (ICNARC), London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Rowan","sequence":"additional","affiliation":[{"name":"Intensive Care National Audit & Research Centre (ICNARC), London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D Nuala","family":"Lucas","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer J","family":"Kurinczuk","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Knight","sequence":"additional","affiliation":[{"name":"National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,8,23]]},"reference":[{"key":"2025121400124095000_6.8.e012323.1","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/S1473-3099(12)70233-5","article-title":"In the dark about sepsis","volume":"12","author":"Senior","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"2025121400124095000_6.8.e012323.2","doi-asserted-by":"publisher","DOI":"10.1586\/eri.12.50"},{"issue":"(Suppl","key":"2025121400124095000_6.8.e012323.3","first-page":"1","article-title":"Saving Mothers\u2019 Lives: reviewing maternal deaths to make motherhood safer: 2006\u20132008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom","volume":"118","author":"Cantwell","year":"2011","journal-title":"BJOG"},{"key":"2025121400124095000_6.8.e012323.4","unstructured":"Knight M , Kenyon S , Brocklehurst P , et al . eds. Saving Lives, Improving Mothers\u2019 Care\u2014Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009\u201312. Oxford: National Perinatal Epidemiology Unit (NPEU), University of Oxford, 2014."},{"key":"2025121400124095000_6.8.e012323.5","unstructured":"Sullivan EA , Hall B , King JF . Maternal deaths in Australia 2003\u20132005. AIHW National Perinatal Statistics Unit: 1\u201351. 2008. http:\/\/www.preru.unsw.edu.au\/PRERUWeb.nsf\/resources\/MD3\/$file\/md3a.pdf (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.6","doi-asserted-by":"publisher","DOI":"10.1080\/00016340902926734"},{"key":"2025121400124095000_6.8.e012323.7","unstructured":"Saucedo M , Deneux-Tharaux C . \u00c9pid\u00e9miologie des morts maternelles en France, 2001\u20132006. Bull Epid\u00e9miol Hebd 2010;no. 2\u20133 :10\u201314."},{"key":"2025121400124095000_6.8.e012323.8","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3182a009c3"},{"key":"2025121400124095000_6.8.e012323.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001672"},{"key":"2025121400124095000_6.8.e012323.10","doi-asserted-by":"publisher","DOI":"10.1186\/cc2834"},{"key":"2025121400124095000_6.8.e012323.11","unstructured":"ICNARC. Quarterly Quality Reports , 2015. https:\/\/www.icnarc.org\/Our-Audit\/Audits\/Cmp\/Reports\/Quarterly-Quality-Report (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.12","doi-asserted-by":"publisher","DOI":"10.1186\/cc4854"},{"key":"2025121400124095000_6.8.e012323.13","unstructured":"Office for National Statistics. Maternities. Office for National Statistics, 2012. http:\/\/www.ons.gov.uk\/ons\/taxonomy\/index.html?nscl=Maternities (accessed 1 Feb 2015)."},{"key":"2025121400124095000_6.8.e012323.14","unstructured":"Northern Ireland Statistics and Research Agency, editor. Births. 2012. http:\/\/www.nisra.gov.uk\/demography\/default.asp8.htm (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.15","unstructured":"Northern Ireland Statistics and Research Agency. Census 2001 results. NISRA, 2012. http:\/\/www.nisra.gov.uk\/Census\/agreement.html (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.16","unstructured":"Hospital Episode Statistics. Hospital episode statistics: maternity data. HES, 2012. http:\/\/www.hesonline.nhs.uk\/ (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.17","unstructured":"StatsWales. Method of delivery. StatsWales, 2012. http:\/\/www.statswales.wales.gov.uk\/TableViewer\/tableView.aspx?ReportId=2021 (accessed 22 Jul 2015)."},{"key":"2025121400124095000_6.8.e012323.18","unstructured":"Black LA . Incidence of caesarean sections. Northern Ireland Assembly, 2011. http:\/\/www.niassembly.gov.uk\/Documents\/RaISe\/Publications\/2011\/Health\/14711.pdf (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.19","unstructured":"Scotland N . Scottish Confidential Audit of Severe Maternal Morbidity. 6th Annual Report. Edinburgh: NHS QIS. 2010. http:\/\/www.healthcareimprovementscotland.org\/programmes\/reproductive,_maternal__child\/programme_resources\/scasmm.aspx (accessed 16 Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.20","unstructured":"Information Services Division. Maternity and births. ISD Scotland, 2012. http:\/\/www.isdscotland.org\/Health-Topics\/Maternity-and-Births\/Publications\/data-tables.asp (accessed Aug 2015)."},{"key":"2025121400124095000_6.8.e012323.21","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000085141.75513.2B"},{"key":"2025121400124095000_6.8.e012323.22","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-100-4-483"},{"key":"2025121400124095000_6.8.e012323.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7294.1089"},{"key":"2025121400124095000_6.8.e012323.24","doi-asserted-by":"publisher","DOI":"10.1086\/591708"},{"key":"2025121400124095000_6.8.e012323.25","first-page":"441","article-title":"Severe acute respiratory infections in the postpandemic era of H1N1","volume":"18","author":"Poulakou","year":"2012","journal-title":"Curr Opin Crit Care"},{"key":"2025121400124095000_6.8.e012323.26","doi-asserted-by":"crossref","first-page":"pii:19785","DOI":"10.2807\/ese.16.05.19785-en","article-title":"Increase in invasive Streptococcus pyogenes and Streptococcus pneumoniae infections in England, December 2010 to January 2011","volume":"16","author":"Zakikhany","year":"2011","journal-title":"Euro Surveill"},{"key":"2025121400124095000_6.8.e012323.27","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1111\/j.1471-0528.2005.00657.x","article-title":"Investigating the relationship between affluence and elective caesarean sections","volume":"112","author":"Alves","year":"2005","journal-title":"BJOG"},{"key":"2025121400124095000_6.8.e012323.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2012.05.014"},{"key":"2025121400124095000_6.8.e012323.29","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/oxfordjournals.pubmed.a024603","article-title":"Social class, spoken language and pattern of care as determinants of continuity of carer in maternity services in east London","volume":"19","author":"Hemingway","year":"1997","journal-title":"J Public Health Med"},{"key":"2025121400124095000_6.8.e012323.30","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/j.1471-0528.2011.03239.x","article-title":"Maternal sepsis: a Scottish population-based case-control study","volume":"119","author":"Acosta","year":"2012","journal-title":"BJOG"},{"key":"2025121400124095000_6.8.e012323.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.099"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2016-012323","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T08:12:50Z","timestamp":1765699970000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2016-012323"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2016,8,23]]},"published-print":{"date-parts":[[2016,8]]}},"alternative-id":["10.1136\/bmjopen-2016-012323"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2016-012323","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.726669405.793564111","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8]]}}}