Knowledge, Attitude and Practice on Maternal Sepsis Among Mothers in Kuantan, Pahang, Malaysia

Maternal sepsis is one of the main contributors to maternal mortality worldwide. Malaysia has the least number of cases associated with maternal sepsis in 2015. However, the number of cases has increase by eight cases in 2017 as stated by the Family Health Development Division Ministry of Health Malaysia. Hence, this study aimed to investigate the knowledge, attitude and practice on maternal sepsis and its associated factors among mothers in Kuantan,Pahang. A cross sectional study design with convenience sampling were applied to 100 respondents among mothers based on specific criteria. From the findings, the majority of the mothers in Kuantan has good level of knowledge (52%), whereas the level of attitude was moderate (85%). In addition, the finding shows that the level of practice among mothers in Kuantan was excellent (76%). Maternal knowledge significantly associated with the age of the mother with p = 0.007. There was a significant correlation between knowledge and attitude (r = 0.433, p = less than 0.001) and knowledge with practice (r = 0.236, p = 0.018). While attitude and practice (r = 0.194, p = 0.053) showed no significant correlation. This study shows that the mothers in Kuantan, Pahang had good level of knowledge, moderate attitude towards maternal sepsis and excellent practice in preventing maternal sepsis. Continues education on maternal sepsis and other risk factors of maternal mortality should be done especially to young mothers in order to control and reduce the the rates of maternal mortality. Furthermore, this can be a benchmark initiative to achieve the targets in reducing maternal mortality rate in Malaysia as outlined under sustainable development goals 3 (SDG3).

Obstetric anaesthesia and analgesia

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications, such as post dural puncture headache (PDPH). It describes anaesthesia for Caesarean section (both regional and general); failed intubation; antacid prophylaxis; postoperative analgesia; retained placenta; in utero fetal death; hypertensive disease of pregnancy (pre-eclampsia, eclampsia and the hypertension, elevated liver enzymes and low platelets (HELLP) syndrome); massive obstetric haemorrhage; placenta praevia and morbidly adherent placenta (placenta accreta, increta and percreta); amniotic fluid embolism (AFE); maternal sepsis, and maternal resuscitation. It discusses comorbidity in pregnancy such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breast-feeding.

The global burden and trends of maternal sepsis and other maternal infections in 204 countries and territories from 1990 to 2019

Background Maternal sepsis and other maternal infections (MSMI) have considerable impacts on women’s and neonatal health, but data on the global burden and trends of MSMI are limited. Comprehensive knowledge of the burden and trend patterns of MSMI is important to allocate resources, facilitate the establishment of tailored prevention strategies and implement effective clinical treatment measures. Methods Based on data from the Global Burden of Disease database, we analysed the global burden of MSMI by the incidence, death, disability-adjusted life year (DALY) and maternal mortality ratio (MMR) in the last 30 years. Then, the trends of MSMI were assessed by the estimated annual percentage change (EAPC) of MMR as well as the age-standardized rate (ASR) of incidence, death and DALY. Moreover, we determined the effect of sociodemographic index (SDI) on MSMI epidemiological parameters. Results Although incident cases almost stabilized from 1990 to 2015, the ASR of incidence, death, DALY and MMR steadily decreased globally from 1990 to 2019. The burden of MSMI was the highest in the low SDI region with the fastest downward trends. MSMI is still one of the most important causes of maternal death in the developed world. Substantial diversity of disease burden and trends occurred in different regions and individual countries, most of which had reduced burden and downward trends. The MMR and ASR were negatively correlated with corresponding SDI value in 2019 in 204 countries/territories and 21 regions. Conclusion These findings highlight significant improvement in MSMI care in the past three decades, particularly in the low and low-middle SDI regions. However, the increased burden and upward trends of MSMI in a few countries and regions are raising concern, which poses a serious challenge to maternal health. More tailored prevention measures and additional resources for maternal health are urgently needed to resolve this problem.

Maternal Sepsis: A Review of National and International Guidelines

Objective Sepsis is a life-threatening syndrome caused by the body's response to infection. The Global Maternal Sepsis Study (GLOSS) suggests sepsis plays a larger role in maternal morbidity and mortality than previously thought. We therefore sought to compare national and international guidelines for maternal sepsis to determine their consistency with each other and the Third International Consensus for Sepsis and Septic Shock (SEPSIS-3). Study Design Using Cochrane Database of Systematic Reviews, PubMed, Google Scholar, and organization Web sites, we identified seven guidelines on maternal sepsis in the English language—The American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Society of Obstetric Medicine of Australia and New Zealand, Royal College of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland Institute of Obstetricians and Gynaecologists, and World Health Organization. Guidelines were reviewed to ascertain the commonality and variation, if any, in definitions of maternal sepsis, tools and criteria utilized for diagnosis, obstetric warning systems used, as well as evaluation and management of maternal sepsis. These variables were also compared with SEPSIS-3. Results All guidelines provided definitions consistent with a version of the SEPSIS, although the specific version utilized were varied. Clinical variables and tools employed for diagnosis of maternal sepsis were also varied. Evaluation and management of maternal sepsis and septic shock were similar. Conclusion In conclusion, national and international maternal sepsis guidelines were incongruent with each other and SEPSIS-3 in diagnostic criteria and tools but similar in evaluation and management recommendations. Key Points

Pregnancy: a stepping-stone to sepsis

The physiological shifts during pregnancy predispose women to a ten-fold higher risk of developing sepsis, a life-threatening condition characterised by a maladapted host-response to infection. We present a comprehensive synthesis of maternal immunity during pregnancy, addressing whether altered set-points in immune homeostasis lower the tipping point for sepsis. This close interconnection between maternal immunity and sepsis makes clinical diagnosis highly challenging and translates to delayed antibiotics or overuse. We propose further understanding of the maternal immune set-point changes are vital for tailoring the right diagnostic tools for maternal sepsis and may unravel pathophysiological pathways that predispose an individual to sepsis.