\n Objective Screening tools, including the Systemic Inflammatory Response Syndrome (SIRS) criteria and Sequential Organ Failure Assessment (SOFA) criteria, have not been validated in the pregnant population. We aimed to determine if pregnancy-specific modifications to the quick SOFA (qSOFA) can improve prediction of severe maternal morbidity in pregnant women with serious infections.

SOMANZ (Society of Obstetric Medicine Australia and New Zealand) has written a guideline to provide evidence-based guidance for the investigation and care of women with sepsis in pregnancy or the postpartum period. The guideline is evidence-based and incorporates recent changes in the definition of sepsis. The etiology, investigation and treatment of bacterial, viral and non-infective causes of sepsis are discussed. Obstetric considerations relevant to anaesthetic and intensive care treatment in sepsis are also addressed. A multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women have contributed to the development of the guidelines. This is an executive summary of the guidelines.© 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

To compare prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy across income settings.PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library databases up to March 30, 2015.Studies including emergency peripartum hysterectomies performed within 6 weeks postpartum. Not eligible were comments, case reports, elective hysterectomies for associated gynecologic conditions, studies with fewer than 10 inclusions, and those reporting only percentages published in languages other than English or before 1980. Interstudy heterogeneity was assessed by χ test for heterogeneity; a random-effects model was applied whenever I exceeded 25%.One hundred twenty-eight studies were selected, including 7,858 women who underwent emergency peripartum hysterectomy, of whom 87% were multiparous. Hysterectomy complicated almost 1 per 1,000 deliveries (range 0.2-10.1). Prevalence differed between poorer (low and lower middle income) and richer (upper middle and high income) settings: 2.8 compared with 0.7 per 1,000 deliveries, respectively (relative risk 4.2, 95% confidence interval [CI] 4.0-4.5). Most common indications were placental pathology (38%), uterine atony (27%), and uterine rupture (26%). Risk indicators included cesarean delivery in the current pregnancy (odds ratio [OR] 11.38, 95% CI 9.28-13.97), previous cesarean delivery (OR 7.5, 95% CI 5.1-11.0), older age (mean difference 6.6 years between women in the case group and those in the control group, 95% CI 4.4-8.9), and higher parity (mean difference 1.4, 95% CI 0.7-2.2). Having attended antenatal care was protective (OR 0.12, 95% CI 0.06-0.25). Only 3% had accessed arterial embolization to prevent hysterectomy. Average blood loss was 3.7 L. Mortality was 5.2 per 100 hysterectomies (reported range 0-59.1) and higher in poorer settings: 11.9 compared with 2.5 per 100 hysterectomies (relative risk 4.8, 95% CI 3.9-5.9).Emergency peripartum hysterectomy is associated with considerable morbidity and mortality and is more frequent in lower-income countries, where it contains a higher risk of mortality. A (previous) cesarean delivery is associated with a higher risk of emergency peripartum hysterectomy.

Pregnancy-related sepsis contributes significantly to maternal mortality. While there is substantial information on postpartum hysterectomy, information on outcomes of hysterectomy as source control for puerperal sepsis is limited. Knowledge of the common causative organisms and their antimicrobial sensitivity may assist with targeted antibiotic therapy to improve patient outcomes. This study described the indications and outcomes of surgery in patients following hysterectomy as source control for puerperal sepsis.In a retrospective study, we analysed the intra-operative and histological findings and the results of microbial culture and antibiotic sensitivity of women who underwent a hysterectomy for puerperal sepsis at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, from January 2019 to December 2019.Twenty-nine (88%) of the 33 women with hysterectomy for puerperal sepsis studied had a caesarean section (CS), 14 (48%) of whom had a CS performed for foetal distress. Eight of these 33 women (24%) had hypertensive-related disorders. The most common organisms cultured in the intra-abdominal fluid were (= 11, 26%), (= 8, 19%), species (= 6, 14%) and (= 6, 14%) of a total of 42 organisms were identified from all sites. Puerperal sepsis was confirmed in 28 (85%) of the uterine histology samples, with a mortality rate of 6% in this study.Hysterectomy for puerperal sepsis was most frequently associated with CS, with hypertensive-related disorders the most common indication. Histological confirmation of sepsis is required, as the histological findings differed by 15% with surgical diagnosis. was the most common species isolated as the cause of infection.© 2025. The Authors.