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Am J Perinatol 2020; 37(05): 453-460
DOI: 10.1055/s-0039-1696721
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risk Factors for Maternal Readmission with Sepsis

Megan E. Foeller 
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Lillian Sie
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Timothy M. Foeller
3   Department of Medicine, Stanford University School of Medicine, Stanford, California
,
Anna I. Girsen
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Suzan L. Carmichael
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Deirdre J. Lyell
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Henry C. Lee
2   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Ronald S. Gibbs 
1   Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Further Information

Publication History

25 March 2019

06 August 2019

Publication Date:
17 September 2019 (online)

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Abstract

Objective Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at readmission and (2) compare early (<6 weeks) and late (6 weeks to 9 months postpartum) maternal readmission with sepsis.

Study Design We identified our cohort using linked hospital discharge data and birth certificates for California deliveries from 2008 to 2011. Consistent with the 2016 sepsis classification, we defined sepsis as septicemia plus acute organ dysfunction. We compared women with early or late readmission with sepsis to women without readmission with sepsis.

Results Among 1,880,264 women, 494 (0.03%) were readmitted with sepsis, 61% after 6 weeks. Risk factors for readmission with sepsis included preterm birth, hemorrhage, obesity, government-provided insurance, and primary cesarean. For both early and late sepsis readmissions, the most common diagnoses were urinary tract infection and pyelonephritis, and the most frequently identified infecting organism was gram-negative bacteria. Women with early compared with late readmission with sepsis shared similar obstetric characteristics.

Conclusion Maternal risk factors for both early and late readmission with sepsis included demographic characteristics, cesarean, hemorrhage, and preterm birth. Risks for sepsis after delivery persist beyond the traditional postpartum period of 6 weeks.

Keywords

pregnancy - postpartum - risk factors - sepsis - infection - readmission

a All codes used were previously validated by a prior report (7). Electroencephalography (code 89.14) was also included in the same prior report but was removed in the current study because it was deemed by study authors to not be directly associated with end organ damage.


Supplementary Material

 

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