{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:53:05Z","timestamp":1792601585130,"version":"4.5.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T00:00:00Z","timestamp":1684195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Maternal sepsis is a life-threatening condition and ranks among the top five causes of maternal death in pregnancy and the postpartum period. Herein, we conducted a retrospective study on sepsis cases to explain the related risk factors by comparing them with bloodstream infection (BSI) and control maternities. In total, 76 sepsis cases were enrolled, and 31 BSI and 57 maternal cases of the same age but with neither sepsis nor BSI were set as controls. Genital tract infection (GTI) and pneumonia were the two most common infection sources in both sepsis (22 cases, 29% and 29 cases, 38%) and BSI cases (18 cases, 58% and 8 cases, 26%). Urinary tract infection (UTI)\/pyelonephritis (9 cases, 12%) and digestive infection cases (11 cases, 14%) only existed in the sepsis group. Significantly different infection sources were discovered between the sepsis-death and sepsis-cure groups. A higher proportion of pneumonia and a lower proportion of GTI cases were present in the sepsis-death group (17 cases, 45% pneumonia and 9 cases, 24% GTI) than in the sepsis-cure group (12 cases, 32% pneumonia and 13 cases, 34% GTI). In addition, although gram-negative bacteria were the dominant infectious microorganisms as previously reported, lower proportion of gram-negative bacteria infectious cases in sepsis (30 cases, 50%) and even lower in sepsis-death group (14 cases, 41%) was shown in this study than previous studies. As expected, significantly greater adverse maternal and fetal outcomes, such as higher maternal mortality (26.3% vs. 0% vs. 0%), higher fetal mortality (42.2% vs. 20.8% vs. 0%), earlier gestational age at delivery (26.4\u2009\u00b1\u20099.5 vs. 32.3\u2009\u00b1\u20098.1 vs. 37.7\u2009\u00b1\u20094.0) and lower newborn weight (1,590\u2009\u00b1\u20091287.8 vs. 2859.2\u2009\u00b1\u2009966.0 vs. 3214.2\u2009\u00b1\u2009506.4), were observed in the sepsis group. This study offered some potential pathogenesis and mortality risk factors for sepsis, which may inspire the treatment of sepsis in the future.<\/jats:p>","DOI":"10.3389\/fmed.2023.1126807","type":"journal-article","created":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T17:53:35Z","timestamp":1684259615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Maternal sepsis in pregnancy and the puerperal periods: a cross-sectional study"],"prefix":"10.3389","volume":"10","author":[{"given":"Ping","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiheng","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhansong","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruilian","family":"Zhe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihua","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shangrong","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1589","DOI":"10.1016\/j.jogc.2019.02.014","article-title":"Severe maternal morbidity in Canada: temporal trends and regional variations, 2003-2016","volume":"41","author":"Dzakpasu","year":"2019","journal-title":"J Obstet Gynaecol Can"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/FM9.0000000000000058","article-title":"New concept and management for sepsis in pregnancy and the puerperium","volume":"2","author":"Fan","year":"2020","journal-title":"Matern-Fet Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1038\/s41372-019-0481-z","article-title":"Rate and causes of severe maternal morbidity at readmission: California births in 2008\u20132012","volume":"40","author":"Girsen","year":"2020","journal-title":"J Perinatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.ijoa.2018.09.010","article-title":"Maternal critical care in resource-limited settings. Narrative review","volume":"37","author":"Vasco","year":"2019","journal-title":"Int J Obstet Anesth"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1097\/AOG.0000000000001028","article-title":"Maternal deaths due to sepsis in the state of Michigan, 1999\u20132006","volume":"126","author":"Bauer","year":"2015","journal-title":"Obstet Gynecol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.ccc.2015.08.010","article-title":"Maternal sepsis and septic shock","volume":"32","author":"Chebbo","year":"2016","journal-title":"Crit Care Clin"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e1001672","DOI":"10.1371\/journal.pmed.1001672","article-title":"Severe maternal sepsis in the UK, 2011\u20132012: a national case-control study","volume":"11","author":"Acosta","year":"2014","journal-title":"PLoS Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"04048","DOI":"10.7189\/jogh.11.04048","article-title":"Causes of maternal mortality in sub-Saharan Africa: a systematic review of studies published from 2015 to 2020","volume":"11","author":"Musarandega","year":"2021","journal-title":"J Glob Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12884-016-0986-9","article-title":"Puerperal sepsis, the leading cause of maternal deaths at a tertiary University Teaching Hospital in Uganda","volume":"16","author":"Ngonzi","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1001\/jama.2019.9818","article-title":"Incidence of maternal sepsis and sepsis-related maternal deaths in the United States","volume":"322","author":"Hensley","year":"2019","journal-title":"JAMA"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1111\/jog.12954","article-title":"Incidence and causes of maternal mortality in the USA","volume":"42","author":"Kuriya","year":"2016","journal-title":"J Obstet Gynaecol Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1111\/1471-0528.12892","article-title":"Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study","volume":"122","author":"Knowles","year":"2015","journal-title":"BJOG"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e116","DOI":"10.1097\/AOG.0000000000004410","article-title":"Antepartum fetal surveillance: ACOG practice bulletin, number 229","volume":"137","year":"2021","journal-title":"Obstet Gynecol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit Care Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1804","DOI":"10.1016\/S0140-6736(20)31609-3","article-title":"Sepsis","volume":"396","author":"von Cube","year":"2020","journal-title":"Lancet"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/ACO.0000000000000077","article-title":"Fetal optimization during maternal sepsis: relevance and response of the obstetric anesthesiologist","volume":"27","author":"Chau","year":"2014","journal-title":"Curr Opin Anaesthesiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1186\/s12884-020-02901-3","article-title":"Human development index of the maternal country of origin and its relationship with maternal near miss: a systematic review of the literature","volume":"20","author":"Garc\u00eda-Tiz\u00f3n Larroca","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1111\/1471-0528.15578","article-title":"Incidence, causes and correlates of maternal near-miss morbidity: a multi-centre cross-sectional study","volume":"126","author":"Oppong","year":"2019","journal-title":"BJOG"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e2124109","DOI":"10.1001\/jamanetworkopen.2021.24109","article-title":"Perinatal outcomes among patients with sepsis during pregnancy","volume":"4","author":"Blauvelt","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1097\/GRF.0000000000000066","article-title":"Severe sepsis during pregnancy","volume":"57","author":"Pacheco","year":"2014","journal-title":"Clin Obstet Gynecol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/NMC.0000000000000339","article-title":"Sepsis in obstetrics: pathophysiology and diagnostic definitions","volume":"42","author":"Parfitt","year":"2017","journal-title":"MCN Am J Matern Child Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1186\/s12879-018-3156-z","article-title":"Progression into sepsis: an individualized process varying by the interaction of comorbidities with the underlying infection","volume":"18","author":"Sinapidis","year":"2018","journal-title":"BMC Infect Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s40560-019-0383-3","article-title":"Variations in infection sites and mortality rates among patients in intensive care units with severe sepsis and septic shock in Japan","volume":"7","author":"Abe","year":"2019","journal-title":"J Intensive Care"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: a unique complexity","volume":"63","author":"Mor","year":"2010","journal-title":"Am J Reprod Immunol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1111\/j.1749-6632.2010.05938.x","article-title":"Inflammation and pregnancy: the role of the immune system at the implantation site","volume":"1221","author":"Mor","year":"2011","journal-title":"Ann N Y Acad Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1213\/ANE.0b013e3182a009c3","article-title":"Maternal sepsis mortality and morbidity during hospitalization for delivery: temporal trends and independent associations for severe sepsis","volume":"117","author":"Bauer","year":"2013","journal-title":"Anesth Analg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s10096-012-1724-5","article-title":"Evolving microbiological epidemiology and high fetal mortality in 135 cases of bacteremia during pregnancy and postpartum","volume":"32","author":"Surgers","year":"2013","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.ijoa.2016.09.003","article-title":"Clinical and microbiological features of maternal sepsis: a retrospective study","volume":"29","author":"Abir","year":"2017","journal-title":"Int J Obstet Anesth"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1613","DOI":"10.1213\/ANE.0000000000003709","article-title":"Risk factors, etiologies, and screening tools for sepsis in pregnant women: a multicenter case-control study","volume":"129","author":"Bauer","year":"2019","journal-title":"Anesth Analg"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e012323","DOI":"10.1136\/bmjopen-2016-012323","article-title":"Maternal morbidity and mortality from severe sepsis: a national cohort study","volume":"6","author":"Acosta","year":"2016","journal-title":"BMJ Open"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1023\/B:THRO.0000014592.27892.11","article-title":"Sepsis and disseminated intravascular coagulation","volume":"16","author":"Levi","year":"2003","journal-title":"J Thromb Thrombolysis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"795.e1","DOI":"10.1016\/j.ajog.2016.07.039","article-title":"Hospital delivery volume, severe obstetrical morbidity, and failure to rescue","volume":"215","author":"Friedman","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1038\/nm.3368","article-title":"Cold-inducible RNA-binding protein (CIRP) triggers inflammatory responses in hemorrhagic shock and sepsis","volume":"19","author":"Qiang","year":"2013","journal-title":"Nat Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e119","DOI":"10.1213\/ANE.0000000000004424","article-title":"Trends in postpartum hemorrhage in the United States from 2010 to 2014","volume":"130","author":"Reale","year":"2020","journal-title":"Anesth Analg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1126807\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,16]],"date-time":"2023-05-16T17:53:39Z","timestamp":1684259619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1126807\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,16]]},"references-count":35,"alternative-id":["10.3389\/fmed.2023.1126807"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1126807","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,16]]},"article-number":"1126807"}}