Analysis of maternal mortality from sepsis in the Vinnytsia region. Ways to improve the diagnosis and treatment from the standpoint of evidence-based medicine

I.L. Kukuruza, N.V. Titarenko, O.I. Datsyuk, О.V. Stolyarchuk

Abstract


In obstetric practice, sepsis remains the most significant cause of maternal mortality, taking the leading rating position in its structure. Sepsis is a cause of at least 75,000 maternal deaths in the world each year, mostly in low-income countries. Incidence of sepsis mortality in high-income countries is about 0.1–0.6 cases per 1,000 births according to the research. In Ukraine in 2015, sepsis ranked the fifth place in the structure of maternal deaths (8.2 %), after extragenital pathology, preeclampsia, amniotic fluid embolism and bleeding. At the same time, in the Vinnytsia region in 2015 sepsis took the first place in the structure of causes of maternal mortality (two out of five women died from sepsis). In the treatment of women with sepsis, the following problems occur most often: underestimation of the severity of the condition, incorrect use of antibiotics and delay of health care. Reduced immune status and increased blood clotting, which take place in pregnancy, are favorable background for generalization of infection and appearance of septic complications. Early diagnosis of sepsis is the basis of possible rescue of a woman. Until recently, the diag­nosis of sepsis was based on the identification of clinical and laboratory signs of systemic inflammatory response syndrome. Bacteriological method can definitely confirm or exclude the diagnosis only in 58 % of cases of sepsis. Sepsis diagnosis should be based on biomarkers, which reflect the modified response to infection (cytokines, procalcitonin, C-reactive protein, presepsin etc.), and the detection of organ dysfunction (qSOFA, SOFA, etc.). In the treatment of obstetric sepsis, the first place belongs to the organization of intensive care based on the observance of the principle of early goal-directed therapy, which allows reducing mortality for 16 % compared with usual modality. This article presents an analysis of maternal deaths from sepsis in 2015 in the Vinnytsia region and modern approaches to improving the diagnosis and treatment of sepsis from the standpoint of evidence-based medicine. Factors, which could prevent mortality, are sepsis verification in accordance with modern criteria of diagnosis, including detection, prevention and treatment of organ disorders.

Keywords


sepsis; maternal mortality; Vinnytsia region

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DOI: https://doi.org/10.22141/2224-0586.3.82.2017.102321

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