Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation.
Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation.
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DOI：
10.1186/s12978-017-0321-6
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发表时间：
2017-05-30
影响因子：
3.4
通讯作者：
Gülmezoglu AM
中科院分区：
文献类型：
--
作者：
Bonet M;Nogueira Pileggi V;Rijken MJ;Coomarasamy A;Lissauer D;Souza JP;Gülmezoglu AM
有必要对孕产妇败血症进行明确和可操作的定义，以便更好地评估这种疾病的负担，及时有效地进行治疗，并在设施和国家之间进行比较。本研究的目的是审查产妇败血症的定义和识别标准，并报告专家咨询的结果，以制定一个新的国际定义产妇败血症。纳入了所有原始和综述文章和WHO文件，以及提供母体败血症定义和/或识别标准的临床指南。2016年3月至4月，通过在线咨询对多学科国际专家小组进行了调查，了解他们对现有脓毒症定义的意见，包括为成人人群提出的脓毒症新定义（2016年第三次脓毒症和脓毒性休克国际共识定义）以及不同标准识别母体脓毒症的重要性。世卫组织和Jhpiego召开的专家面对面共识发展会议通过迭代过程商定了该定义。标准化母体败血症的定义并使其与成人人群中败血症的当前理解保持一致被认为是专家小组改善母体败血症负担评估的强制性步骤。文献综述和专家咨询产生了一个新的WHO共识定义：“孕产妇败血症是一种危及生命的疾病，定义为妊娠、分娩、流产后或产后期间感染导致的器官功能障碍”。正在制定计划，以在大量国际人群中验证世卫组织对孕产妇败血症的新定义。新的孕产妇败血症定义的可操作性需要产生一套实用的标准，以确定妇女败血症。这些标准应使临床医生能够专注于及时启动可操作的护理要素（抗菌药物和液体的管理，重要器官功能的支持和转诊），并改善孕产妇结局。本文的在线版本（doi：10.1186/s12978-017-0321-6）包含补充材料，可供授权用户使用。
There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis. All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego. Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition “Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period”. Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population. The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of care (administration of antimicrobials and fluids, support of vital organ functions, and referral) and improve maternal outcomes. The online version of this article (doi:10.1186/s12978-017-0321-6) contains supplementary material, which is available to authorized users.