Assessing patient-level risk factors for evidence-based early diagnosis of maternal sepsis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Maternal sepsis is a leading cause of maternal death, with the burden higher in low- and middle-income countries (LMICs). Early Warning Systems (EWS) combine clinical observations to identify a pattern consistent with an increased risk of clinical deterioration and have been introduced for monitoring sepsis risk. Maternal sepsis risks in LMICs are driven by factors at the health system and patient levels. This study assessed patient-level risk factors -age, health-seeking behaviour, comorbidities and procedures- associated with maternal sepsis in an urban tertiary hospital in Nigeria.
Methods
We conducted a retrospective study using health records of 4,510 patients from obstetrics and gynaecology units at a tertiary hospital in southwestern Nigeria from 2016 to 2020. To examine the association between patient-level risk factors and sepsis, we analysed data for the 565 maternal patients with a record of infection using a multiple logistic regression model. We extended the model by introducing interaction terms to assess whether the association between the risk factors and maternal sepsis varied by socio-demographic factors.
Results
About one-fifth of the 565 maternal patients with an infection had sepsis. Patients with sepsis had the lowest rate of live birth (29.7%) compared to those with (41.8%) and without (82.1%) an infection. Proportions of stillbirth (intrauterine fetal death) and early neonatal deaths were highest among patients with sepsis (15.3% and 1.8%) compared to those with (13.2% and 2.1%) and without (4.5% and 1.7%) an infection. Antenatal care booking status (OR: 0.17; 95% CI: 0.08–0.38) and having a catheter (OR: 2.60; 95% CI: 1.35–5.01) were significantly associated with maternal sepsis in the adjusted model.
Conclusion
Our results suggest that improving access to antenatal care services for pregnant women will substantially reduce the risk of maternal sepsis in the Nigerian population. Guidelines for maternal sepsis management should consider subgroups of patients at higher risk, such as those with urethral catheters.
Maternal sepsis is a leading cause of maternal death, with the burden higher in low- and middle-income countries (LMICs). Early Warning Systems (EWS) combine clinical observations to identify a pattern consistent with an increased risk of clinical deterioration and have been introduced for monitoring sepsis risk. Maternal sepsis risks in LMICs are driven by factors at the health system and patient levels. This study assessed patient-level risk factors -age, health-seeking behaviour, comorbidities and procedures- associated with maternal sepsis in an urban tertiary hospital in Nigeria.
Methods
We conducted a retrospective study using health records of 4,510 patients from obstetrics and gynaecology units at a tertiary hospital in southwestern Nigeria from 2016 to 2020. To examine the association between patient-level risk factors and sepsis, we analysed data for the 565 maternal patients with a record of infection using a multiple logistic regression model. We extended the model by introducing interaction terms to assess whether the association between the risk factors and maternal sepsis varied by socio-demographic factors.
Results
About one-fifth of the 565 maternal patients with an infection had sepsis. Patients with sepsis had the lowest rate of live birth (29.7%) compared to those with (41.8%) and without (82.1%) an infection. Proportions of stillbirth (intrauterine fetal death) and early neonatal deaths were highest among patients with sepsis (15.3% and 1.8%) compared to those with (13.2% and 2.1%) and without (4.5% and 1.7%) an infection. Antenatal care booking status (OR: 0.17; 95% CI: 0.08–0.38) and having a catheter (OR: 2.60; 95% CI: 1.35–5.01) were significantly associated with maternal sepsis in the adjusted model.
Conclusion
Our results suggest that improving access to antenatal care services for pregnant women will substantially reduce the risk of maternal sepsis in the Nigerian population. Guidelines for maternal sepsis management should consider subgroups of patients at higher risk, such as those with urethral catheters.
Date Issued
2025-07-22
Date Acceptance
2025-07-01
Citation
BMC Pregnancy and Childbirth, 2025, 25
ISSN
1471-2393
Publisher
BMC
Journal / Book Title
BMC Pregnancy and Childbirth
Volume
25
Copyright Statement
© The Author(s) 2025 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40696302
PII: 10.1186/s12884-025-07895-4
Subjects
COUNTRIES
Life Sciences & Biomedicine
Obstetrics & Gynecology
Science & Technology
Publication Status
Published
Coverage Spatial
England
Article Number
782
Date Publish Online
2025-07-22