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Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study

T Culling, C Bertorelli, A Strang, S Oram, F Faggian, S Sharma, A Ridgeway, Summia Zaher, Mario Labeta, Simon A Jones, Luke Davies Orcid Logo, John Watkins, Kate Siddall, Vikki Keeping, Kathryn Simpson, Maryanne Bray, Peter Ghazal, Sarah F Bell, Rachel E Collis

International Journal of Obstetric Anesthesia, Volume: 63, Start page: 104683

Swansea University Author: Luke Davies Orcid Logo

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DOI (Published version): 10.1016/j.ijoa.2025.104683

Abstract

Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinde...

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Published in: International Journal of Obstetric Anesthesia
ISSN: 0959-289X 1532-3374
Published: Elsevier Ltd 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69675
first_indexed 2025-06-11T09:09:28Z
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This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis. Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: 'infection confirmed', 'infection unknown' and 'infection unlikely'. Differences in physiological and routine laboratory variables were investigated. Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between 'infection confirmed' (n=58) and 'infection unlikely' (n=17) showed statistical differences in temperature (P&#xA0;&lt;0.001), neutrophil count (P&#xA0;=0.003) and leukocyte count (P&#xA0;=0.004) at the time of recruitment. 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When temperature&#xA0;&#x2265;37.5&#xB0;C persists, medical care should be expedited and maternal infection considered.</abstract><type>Journal Article</type><journal>International Journal of Obstetric Anesthesia</journal><volume>63</volume><journalNumber/><paginationStart>104683</paginationStart><paginationEnd/><publisher>Elsevier Ltd</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0959-289X</issnPrint><issnElectronic>1532-3374</issnElectronic><keywords>Diagnosis; Fever; Infection; Pregnancy; Sepsis; Maternal morbidity; Maternal mortality; MEOWS</keywords><publishedDay>1</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-08-01</publishedDate><doi>10.1016/j.ijoa.2025.104683</doi><url/><notes>Brief Report</notes><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>This project was funded by a grant awarded by the National Institute of Academic Anaesthesia (NIAA19R103). 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spelling 2025-06-11T10:35:34.7958612 v2 69675 2025-06-11 Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study ff080296775381560053d5e3a6e81745 0000-0001-7767-4060 Luke Davies Luke Davies true false 2025-06-11 MEDS Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis. Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: 'infection confirmed', 'infection unknown' and 'infection unlikely'. Differences in physiological and routine laboratory variables were investigated. Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between 'infection confirmed' (n=58) and 'infection unlikely' (n=17) showed statistical differences in temperature (P <0.001), neutrophil count (P =0.003) and leukocyte count (P =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, P <0.0001) with an optimal threshold of ≥37.5°C. This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered. Journal Article International Journal of Obstetric Anesthesia 63 104683 Elsevier Ltd 0959-289X 1532-3374 Diagnosis; Fever; Infection; Pregnancy; Sepsis; Maternal morbidity; Maternal mortality; MEOWS 1 8 2025 2025-08-01 10.1016/j.ijoa.2025.104683 Brief Report COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This project was funded by a grant awarded by the National Institute of Academic Anaesthesia (NIAA19R103). Additional funding provided by the Welsh Government through the European Regional Development Fund (Ser Cymru Grant Program: 80762-CU-106) awarded to PG for Project Sepsis. LCD is funded by a Medical Research Council New Investigator Research Grant (MR/Y013816/1). SFB is funded by a Health and Care Research Wales Research Time Award. 2025-06-11T10:35:34.7958612 2025-06-11T10:02:14.3353248 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science T Culling 1 C Bertorelli 2 A Strang 3 S Oram 4 F Faggian 5 S Sharma 6 A Ridgeway 7 Summia Zaher 8 Mario Labeta 9 Simon A Jones 10 Luke Davies 0000-0001-7767-4060 11 John Watkins 12 Kate Siddall 13 Vikki Keeping 14 Kathryn Simpson 15 Maryanne Bray 16 Peter Ghazal 17 Sarah F Bell 18 Rachel E Collis 19 69675__34457__960934d48db94549aad08ae4b86ad890.pdf 69675.VOR.pdf 2025-06-11T10:08:02.4502750 Output 2368231 application/pdf Version of Record true © 2025 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license. true eng http://creativecommons.org/licenses/by/4.0/
title Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
spellingShingle Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
Luke Davies
title_short Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
title_full Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
title_fullStr Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
title_full_unstemmed Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
title_sort Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study
author_id_str_mv ff080296775381560053d5e3a6e81745
author_id_fullname_str_mv ff080296775381560053d5e3a6e81745_***_Luke Davies
author Luke Davies
author2 T Culling
C Bertorelli
A Strang
S Oram
F Faggian
S Sharma
A Ridgeway
Summia Zaher
Mario Labeta
Simon A Jones
Luke Davies
John Watkins
Kate Siddall
Vikki Keeping
Kathryn Simpson
Maryanne Bray
Peter Ghazal
Sarah F Bell
Rachel E Collis
format Journal article
container_title International Journal of Obstetric Anesthesia
container_volume 63
container_start_page 104683
publishDate 2025
institution Swansea University
issn 0959-289X
1532-3374
doi_str_mv 10.1016/j.ijoa.2025.104683
publisher Elsevier Ltd
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
active_str 0
description Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis. Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: 'infection confirmed', 'infection unknown' and 'infection unlikely'. Differences in physiological and routine laboratory variables were investigated. Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between 'infection confirmed' (n=58) and 'infection unlikely' (n=17) showed statistical differences in temperature (P <0.001), neutrophil count (P =0.003) and leukocyte count (P =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, P <0.0001) with an optimal threshold of ≥37.5°C. This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered.
published_date 2025-08-01T05:28:49Z
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