Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States

Matthew K. Hensley, Melissa E. Bauer, Lindsay K. Admon, et al.

JAMA. 2019;322(9):890-892. doi:10.1001/jama.2019.9818

Results

From 63 665 593 hospitalizations in the NRD (2013-2016), there were 5 957 678 delivery hospitalizations with discharges in January through October, of which 32.5% were cesarean deliveries. There were 2905 deliveries complicated by sepsis (0.038%; 95% CI, 0.037%-0.040%); 49.8% (95% CI, 47.7%-52.0%) were complicated during delivery hospitalization and 50.3% (95% CI, 48.1%-52.4%) after delivery discharge. Sepsis readmissions occurred a mean of 13.6 (SD, 11.2) days after discharge from delivery hospitalization.

Maternal sepsis episodes after delivery discharge, compared with during delivery hospitalization, occurred in women with fewer comorbidities (mean, 1.9 vs 2.6; difference, −0.7 [95% CI, −0.8 to −0.5]; P < .001), were less frequently associated with cesarean deliveries (49.6% vs 63.7%; difference, −15.7% [95% CI, −19.2% to −12.1%]; P < .001), had a higher percentage of acute kidney dysfunction (35.2% vs 23.9%; difference, 10.6% [95% CI, 7.3%-13.9%]; P < .001), and had a lower percentage of genitourinary infection (39.8% vs 49.2%; difference, −7.5% [95% CI, −11.1% to −3.9%]; P < .001) (Table 1).

There were 408 delivery hospitalizations (0.007%; 95% CI, 0.006%-0.007%) that were followed by maternal death; 74.4% (95% CI, 69.6%-78.6%) during delivery hospitalization and 25.6% (95% CI, 21.4%-30.4%) after delivery discharge (Table 2). Overall, 95 (22.6%; 95% CI, 18.7%-27.1%) of the maternal deaths were sepsis-related; 17.3% (95% CI, 13.2%-22.4%) occurred during delivery hospitalization and 38.1% (95% CI, 29.0%-48.1%) occurred after delivery discharge.