A recent paper published in BMC Pregnancy and Childbirth used data from 15 facilities across 11 GLOSS countries to conduct a virtual confidential inquiry to understand factors linked to infection-related maternal deaths and near-miss. The paper also provides with suggested actions, including the implementation of virtual platforms to improve routine adoption of confidential reviews.
Remember to visit our resources page for other resources to use in your facilities.
Background: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement.
Methods: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework.
Results: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections.
Conclusion: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.
WHO recently launched a new training course on infection prevention and control for maternal and neonatal care. The course is aimed at staff working in maternal and neonatal wards, specifically, antenatal care outpatient services, maternal and neonatal inpatient services, and neonatal intensive care services.
The course is divided into 6 sessions. The first session covers the essential knowledge of standard precautions required for good infection prevention and control. The other five sessions develop this knowledge and apply it clinically to common situations in antenatal care, labour, childbirth and neonatal care. Currently the first three sessions are available.
Module 1: Introduction to Infection prevention and control
Module 2: Care of the pregnant woman in antenatal clinic
Module 3: Admission of the pregnant woman, labour and uncomplicated childbirth
Module 4: When interventions are required in labour (in production)
Module 5: Caesarean section (in production)
Module 6: Special neonatal circumstances (in production)
Identification week for GLOSS ended on 04 December. In total, facilities around the globe identified more than 2 700 women with signs of infection or sepsis. The researchers are now following up with all hospitalized women until discharge. Results will be tabulated and shared in 2018.
Providers from about 500 facilities have been busy this week identifying eligible women for GLOSS, and have recruited over 2 000 women so far (still several hours more to go!). This is an extraordinary, collective effort. Want to see what the global coordination looks like on the map?
Thanks to a great campaign launched in all the facilities informing providers about the study and common identifying signs for maternal sepsis, everyone is ready to support GLOSS. Providers also helped in developing the campaign by telling us what they knew, how they felt about it, and what difficulties they faced when identifying and managing sepsis through a survey. Representatives of 47 countries completed over 1 000 surveys. The survey was available in eight languages, and 578 responded in Spanish, 272 in English, and 117 in Russian. The country with the most completed surveys was Guatemala, followed by Colombia, and then Lithuania. True champions in our awareness campaign activities!
Thanks to everyone who participated in the survey and in putting together this great campaign. The campaign aimed to raise provider awareness on maternal sepsis so that they could be in tune with identifying women with this condition.
More to come as identification week comes to a close.
Our GLOSS colleagues María Fernanda Escobar and Javier Carvajal, together with Adriana Messa from Fundación Valle de Lili in Cali, Colombia have created a new video to showcase STOP SEPEIS campaign information about sepsis during pregnancy. The “Sepsis en embarazo” video is being shown on TV screens in the Fundación Valle del Lili during the data preparation and collection phases of the Global Maternal Sepsis Study. It is a wonderful demonstration of the campaign in action and an invaluable resource for healthcare practitioners and patients.
Note: video is available in Spanish language only.
his week is World Antimicrobial Awareness Week, a WHO initiative to raise awareness for a serious public health threat: antimicrobial resistance (AMR). Antibiotics are an important tool in effectively treating infections, including maternal and neonatal sepsis. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others.
To prevent and control the spread of antibiotic resistance, healthcare providers can:
Prevent infections by ensuring hands, instruments, and environment is clean.
Only prescribe and dispense antibiotics when they are needed, according to current guidelines.
Report antibiotic-resistant infections to surveillance teams.
Talk to patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
Talk to patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
You can learn more about World Antimicrobial Awareness Week and download information and tools here.
In facilities around the world, healthcare providers are getting ready the start of GLOSS, which will take place 28 November to 4 December 2017. It’s exciting to see the STOP SEPSIS campaign in action.