Compliance with maternal sepsis guidelines in a tertiary hospital in the Netherlands

Figures & data

Figure 1. Participants included in the study.

Table 1. Characteristics, adverse events and underlying cause of infection of women with a suspected sepsis and a clinical diagnosis of sepsis.

	Suspected sepsis n = 252 (100%)		Sepsis n = 22 (100%)
Admissions^a	N	%	N	%
Timing of admission
2^nd trimester	15	6.0	3	13.6
3^rd trimester	21	8.3	2	9.1
During birth	157	62.3	8	36.4
Postpartum	59	23.4	9	40.9
Cesarean section	84	33.3	8	36.4
Adverse events
Transfer to ICU	3	1.3	2	9.1
Surgical intervention^b	23	9.1	7	31.8
Maternal death	0	0	0	0
	Suspected sepsis N = 262 (100%)		Sepsis N = 22 (100%)
Infections^a	N	%	N	%
Primary source of infection
Breast	12	4.6	0	0
Chorioamnionitis	22	8.4	3	13.6
Endometritis	34	13.0	7	31.8
Gastrointestinal tract	6	2.3	0	0
Respiratory tract	1	0.4	0	0
Skin or soft tissue	3	1.1	0	0
Urinary tract	27	10.3	4	18.2
Vulvovaginal	2	0.8	0	0
Unknown	150	57.3	8	36.4
Other ^c	5	1.9	0	0

Abbreviations: ICU (intensive care unit).

^aOut of 240 women, ten women were admitted twice. Six of these women were admitted once during labor and once postpartum. Four women were admitted twice postpartum. One woman was admitted 3 times postpartum. In ten of all 252 admissions, two separate infections were identified. Thus, we identified 262 infections in total.

^bSurgical intervention included: debridement or drainage (N = 4), dilatation and curettage (N = 14), hysteroscopic resection (N = 1), appendectomy (N = 3) and diagnostic laparoscopy (N = 1).

^cOther causes of infection included: four cases of upper respiratory viral infection, one case of urolithiasis presenting with fever.

Figure 2. Compliance with RRT protocol.

Abbreviations: RRT (Rapid Response Team), OEWS (Obstetric Early Warning Score).

The 432 OEWS values were recorded in 73 women.

Compliance for each step was calculated as the fraction of the number of OEWS measurements for which the current step was executed and the number of OEWS measurements for which the previous step was executed. This fraction was expressed as a percentage.

Table 2. Compliance with the SSC hour-1 bundle.

				Time
		Performed (N = 22)		≤60 min		>60 min
Recommendation		N	%	N	%	N	%	Range (min)
Lactate level^a		4	18.2	1	4.5	3	13.6	80–1397
Blood cultures	Performed (total)	22	100	19	86.4	3	13.6	61–606
	Before antibiotics	17	77.3
Antibiotics		22	100	14	63.6	8	36.4	72–439
Crystalloid fluid^b,c		18	81.8	10	45.5	0	0.0
Vasopressors^d		0	0	-		-

^aIn one case, lactate was >2 mmol/l. Lactate was not measured again.

^bHypotension, defined as mean arterial pressure <65 mm Hg, was recorded in one of 22 women, to whom no crystalloids were administered. No lactate >4 mmol/l was recorded.

^cTime of intravenous infusion of crystalloid fluid was not recorded in 8 cases.

^dNone of the women reported hypotension during crystalloid fluid administration, thus no vasopressors were administered.

Data availability statement

Data and materials supporting the results presented in this paper are available upon reasonable request to the corresponding author.