Pregnancy and Sepsis
摘要
Sepsis is a life-threatening condition characterized by organ dysfunction resulting from a dysregulated host response to infection. It occurs when the body’s immune response to infection triggers widespread inflammation, leading to multiorgan impairment. The Sequential Organ Failure Assessment (SOFA) score is commonly utilized to evaluate sepsis severity. This scoring system assesses six organ systems: respiratory, coagulation, liver, cardiovascular, renal, and neurological, assigning each a score from 0 to 4. The cumulative score ranges from 0 to 24, with higher scores indicating greater organ dysfunction and increased mortality risk. Under the Sepsis-3 definition, sepsis is diagnosed when there is an increase of two or more points in the SOFA score in the context of suspected infection. In its most severe form, septic shock is defined by persistent hypotension requiring vasopressors to maintain a mean arterial pressure (MAP) of ≥65 mmHg, along with serum lactate levels >2 mmol/L despite adequate fluid resuscitation. Maternal sepsis is a growing global health concern and one of the leading causes of maternal morbidity and mortality, particularly in low- and middle-income countries. Sepsis accounts for approximately 11% of maternal deaths globally, making it the third most common direct cause. Disparities are significant across regions, with sub-Saharan Africa and Southern Asia reporting the highest incidence. Even in high-income countries, incidence rates range from 9 to 49 cases per 100,000 live births depending on diagnostic criteria. Over the past decade, there has been a notable increase in the incidence of puerperal and severe sepsis, particularly attributed to the growing virulence of Group A Streptococcus (GAS). This pathogen is now responsible for nearly half of direct maternal sepsis deaths in Europe, with the highly virulent emm1 and emm28 genotypes being associated with significantly elevated mortality rates. Rising maternal risk factors such as obesity, cesarean deliveries, advanced maternal age, and chronic conditions further amplify susceptibility to severe infections.