Table 3.
Characteristics of maternal infections and management by severity group
| All women (n=2850) | Less severe infections (n=1835) | Infections with complications*(n=634) | Infection-related severe maternal outcome†(n=381) | p value‡ | ||
|---|---|---|---|---|---|---|
| Primary source of infection identified§ | 2271 (79·7%) | 1368 (74·6%) | 579 (91·3%) | 324 (85·0%) | <0·0001 | |
| Source of infection§ | ||||||
| Urinary tract | 632 (27·9%) | 504 (36·8%) | 69 (12·0%) | 59 (18·2%) | .. | |
| Endometritis | 343 (15·1%) | 178 (13·0%) | 88 (15·3%) | 77 (23·8%) | .. | |
| Chorioamnionitis | 338 (14·9%) | 238 (17·4%) | 66 (11·5%) | 34 (10·5%) | .. | |
| Skin or soft tissue | 336 (14·8%) | 105 (7·7%) | 185 (32·2%) | 46 (14·2%) | .. | |
| Respiratory | 204 (9·0%) | 116 (8·5%) | 21 (3·7%) | 67 (20·7%) | .. | |
| Abortion-related¶ | 193 (8·5%) | 33 (2·4%) | 115 (19·9%) | 45 (13·9%) | .. | |
| Bloodstream | 115 (5·1%) | 97 (7·1%) | 7 (1·2%) | 11 (3·4%) | .. | |
| Peritonitis or abdominal cavity | 69 (3·0%) | 4 (0·3%) | 27 (4·7%) | 38 (11·7%) | .. | |
| Gastrointestinal | 63 (2·8%) | 39 (2·9%) | 11 (1·9%) | 13 (4·0%) | .. | |
| Breast | 30 (1·3%) | 22 (1·6%) | 5 (0·9%) | 3 (0·9%) | .. | |
| CNS | 10 (0·4%) | 3 (0·2%) | 1 (0·2%) | 6 (1·9%) | .. | |
| Other | 197 (9·2%) | 132 (10·6%) | 42 (8·0%) | 23 (7·1%) | .. | |
| Method of identification of the infection if source identified | ||||||
| Clinical examination alone | 910 (40·1%) | 526 (38·5%) | 282 (48·7%) | 102 (31·5%) | .. | |
| Clinical examination and laboratory test | 890 (39·2%) | 648 (47·4%) | 159 (27·5%) | 83 (25·6%) | .. | |
| Clinical examination and imaging | 201 (8·8%) | 85 (6·3%) | 49 (8·5%) | 67 (20·6%) | .. | |
| Clinical examination, laboratory, test, and imaging | 267 (11·7%) | 107 (7·8%) | 88 (15·2%) | 72 (22·2%) | .. | |
| Complete set of vital signs recorded on day infection was suspected or confirmed | 1821 (63·9%) | 1100 (59·9%) | 435 (68·6%) | 286 (75·1%) | 0·0093 | |
| Antimicrobials started the day of suspicion or diagnosis of infection‖ | 1875 (70·2%) | 1198 (70·6%) | 435 (71·6%) | 243 (66·4%) | 0·37 | |
| Antibiotics started the day of suspicion or diagnosis of infection‖ | 1843 (70·2%) | 1165 (70·5%) | 435 (71·7%) | 243 (66·4%) | 0·58 | |
| Sample for culture drawn at any time** | 1269 (46·6%) | 788 (46·0%) | 280 (44·7%) | 201 (52·8%) | 0·19 | |
| Sample for culture drawn before administration of antibiotics | 760/1177 (64·6%) | 496/745 (66·6%) | 165/254 (65·0%) | 99/178 (55·6%) | 0·044 | |
| Any microorganism identified by any method†† | 590 (21·2%) | 360 (20·0%) | 147 (25·6%) | 101 (31·2%) | 0·0017 | |
| Any positive culture of any body fluid** | 579 (25·6%) | 331 (24·2%) | 133 (21·6%) | 97 (26·1%) | 0·011 | |
| All microorganisms identified by any methods‡‡ | ||||||
| Bacteria | 455 (77·1%) | 257 (71·4%) | 116 (87·2%) | 82 (84·5%) | .. | |
| Fungi | 47 (8·0 %) | 30 (8·3%) | 6 (4·5%) | 11 (11·3%) | .. | |
| Parasite | 94 (15·9%) | 79 (21·9%) | 7 (5·3%) | 8 (8·2%) | .. | |
| Virus | 21 (3·6%) | 13 (3·6%) | 3 (2·3%) | 5 (5·1%) | .. | |
| Additional management to control the source of infection§§ | ||||||
| Vacuum aspiration | 108 (4·0 %) | .. | 83 (13·0 %) | 25 (7·0 %) | .. | |
| Dilatation and curettage | 160 (5·6%) | .. | 131 (20·7%) | 29 (7·6%) | .. | |
| Wound debridement | 162 (5·7%) | .. | 136 (21·5%) | 26 (6·8%) | .. | |
| Drainage (incision, percutaneous, culdotomy) | 153 (5·4%) | .. | 102 (16·0%) | 51 (13·4%) | .. | |
| Hysterectomy | 55 (1·9%) | .. | 0 | 55 (14·4%) | .. | |
| Laparotomy and lavage | 201 (8·0%) | .. | 111 (17·5%) | 90 (23·6 %) | .. | |
| Other surgery | 86 (3·2%) | .. | 64 (10·1%) | 22 (5·8%) | .. | |
| Median length of stay in health facility, days (IQR) | 5 (3–9) | 5 (3–7) | 7 (4–11) | 9 (5–17) | <0·0001 | |
| Admission to intensive or high dependency care | 355 (13·8%) | .. | 167 (27·7%) | 188 (49·3%) | <0·0001 | |
Data are n (%), n/N (%), or median (IQR) unless specified.
Includes women who had an invasive procedure to treat the source of infection (vacuum aspiration, dilatation and curettage, wound debridement, drainage [incision, percutaneous, culdotomy] laparotomy and lavage, other surgery), admission to intensive care or high dependency unit, or transfer to another facility.
Maternal death or near-miss. Geographical areas in six western European countries (Belgium, Denmark, Italy, Spain, the Netherlands, the UK) did not collect data on WHO near-miss criteria.
Multinomial mixed models for percentages and linear model for logarithm (length of stay) adjusting for clustering at country level.
More than one source bpossible.
Women who had an abortion, ectopic, or molar pregnancy.
Same day or previous day after 1800 h.
Includes culture drawn at entry in study or any time during stay in the facility.
Includes culture of any body fluid, microscopy, or specific test (eg, malaria, tuberculosis, HIV).
Includes all organisms identified in women without inferring causation (when organism identified). Each woman could have more than one type of microorganism identified.
More than one intervention possible.