Maternal critical illness with special reference to sepsis – A comparison

Background: Critical illness in a pregnant lady may occur due to pre-existing medical diseases, from diseases that are concomitant to pregnancy, or conditions that are peculiar to pregnancy. Sepsis is a leading cause of critical illness with high maternal morbidity and mortality in India and worldwide as well. This study was performed to analyze critical diseases in pregnant, postpartum and postabortal women with particular focus on maternal sepsis in a tertiary care hospital in North India.Materials and Methods: A prospective cross-sectional study was done to analyse all critically ill pregnant women and women within 42 days of delivery or abortion for a study period of one year. Based on the causes of critical illness, Group S (those having sepsis/septic shock) and Group O (those who had critical illnesses excluding sepsis) were defined. Demographic, clinical, microbiological and feto-maternal outcome were recorded and analysed after comparing the parameters between Group S and Group O.Results: Out of 181 critically ill patients, 55 were due to sepsis and 126 were due to other causes. The prevalence of maternal sepsis was 8.4/1000 live births. Out of 181 cases, 75% of the cases were unbooked, 66.3% patients presented antenatally while 27.6% presented in postpartum period and 6.1% were postabortal. The number of maternal deaths attributable to maternal critical illness were 26 which included 61.5% due to sepsis and 38.5% due to other causes of critical illness. In terms of foetal outcome, preterm births were less common in Group S (40%) as compared to Group O (44.4%). NICU admission were also lesser in Group S (32.7%) as compared to Group O (40%).Group S had less number of perinatal deaths (7/55, 12.7%) as compared to Group O (19/126, 15.1%).Conclusion: Critical diseases can make any pregnancy difficult to manage. Monitoring of early warning scores can tell in advance about the clinical deterioration. Maternal sepsis remains a dangerous cause of both maternal and fetal morbidity and mortality. Successful maternal and neonatal outcomes are largely dependent on early recognition and prompt management of maternal sepsis by a multidisciplinary team.