Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context
Summary: Background: Infections and sepsis are leading causes of morbidity and mortality in women during pregnancy and the post-pregnancy period. Using data from the 2017 WHO Global Maternal Sepsis Study, we explored the use of early warning systems (EWS) in women at risk of sepsis-related severe m...
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2025-01-01
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| author | Yamikani Chimwaza Alexandra Hunt Livia Oliveira-Ciabati Laura Bonnett Edgardo Abalos Cristina Cuesta João Paulo Souza Mercedes Bonet Vanessa Brizuela David Lissauer Yamikani Chimwaza Alexandra Hunt Livia Oliveira-Ciabati Laura Bonnett Edgardo Abalos Cristina Cuesta João Paulo Souza Mercedes Bonet Vanessa Brizuela David Lissauer Mohammad Iqbal Aman Bashir Noormal Marisa Espinoza Julia Pasquale Charlotte Leroy Kristien Roelens Griet Vandenberghe M. Christian Urlyss Agossou Sourou Goufodji Keke Christiane Tshabu Aguemon Patricia Soledad Apaza Peralta Víctor Conde Altamirano Rosalinda Hernández Muñoz José Guilherme Cecatti Carolina Ribeiro do Valle Vincent Batiene Kadari Cisse Henri Gautier Ouedraogo Kannitha Cheang Phirun Lam Tung Rathavy Elie Simo Pierre-Marie Tebeu Emah Irene Yakana Javier Carvajal María Fernanda Escobar Paula Fernández Lotte Berdiin Colmorn Jens Langhoff-Roos Wilson Mereci Paola Vélez Yasser Salah Eldin Alaa Sultan Alula M. Teklu Dawit Worku Richard Adanu Philip Govule Charles Noora Lwanga William Enrique Arriaga Romero María Guadalupe Flores Aceituno Carolina Bustillo Bredy Lara Vijay Kumar Vanita Suri Sonia Trikha Irene Cetin Serena Donati Carlo Personeni Guldana Baimussanova Saule Kabylova Balgyn Sagyndykova George Gwako Alfred Osoti Zahida Qureshi Raisa Asylbasheva Aigul Boobekova Damira Seksenbaeva Saad Eddine Itani Meilė Minkauskienė Diana Ramašauskaitė Owen Chikhwaza Luis Gadama Eddie Malunga Haoua Dembele Hamadoun Sangho Fanta Eliane Zerbo Filiberto Dávila Serapio Nazarea Herrera Maldonado Juan I. Islas Castañeda Tatiana Cauaus Ala Curteanu Victor Petrov Yadamsuren Buyanjargal Seded Khishgee Bat-Erdene Lkhagvasuren Amina Essolbi Rachid Moulki Zara Jaze Arlete Mariano Nafissa Bique Osman Hla Mya Thway Einda Thae Maung Maung Khaing Nwe Tin Tara Gurung Amir Babu Shrestha Sangeeta Shrestha Kitty Bloemenkamp Marcus J. Rijken Thomas Van Den Akker María Esther Estrada Néstor J. Pavón Gómez Olubukola Adesina Chris Aimakhu Bukola Fawole Rizwana Chaudhri Saima Hamid M. Adnan Khan María del Pilar Huatuco Hernández Nelly M. Zavaleta Pimentel Maria Lu Andal Zenaida Dy Recidoro Carolina Paula Martin Mihaela Budianu Lucian Pușcașiu Léopold Diouf Dembo Guirassy Philippe Marc Moreira Miroslav Borovsky Ladislav Kovac Alexandra Kristufkova Sylvia Cebekhulu Laura Cornelissen Priya Soma-Pillay Vicenç Cararach Marta López María José Vidal Benedé Hemali Jayakody Kapila Jayaratne Dhammica Rowel Wisal Nabag Sara Omer Victoria Tsoy Urunbish Uzakova Dilrabo Yunusova Thitiporn Siriwachirachai Thumwadee Tangsiriwatthana Catherine Dunlop Marian Knight Jhon Roman Gerardo Vitureira Dinh Anh Tuan Luong Ngoc Truong Nghiem Thi Xuan Hanh Mugove Madziyire Thulani Magwali Stephen Munjanja Adama Baguiya Mónica Chamillard Bukola Fawole Marian Knight Seni Kouanda Pisake Lumbiganon Ashraf Nabhan Ruta Nadisauskiene Linda Bartlett Fernando Bellissimo-Rodrigues Shevin T. Jacob Sadia Shakoor Khalid Yunis Liana Campodónico Hugo Gamerro Daniel Giordano Fernando Althabe A. Metin Gülmezoglu |
| author_facet | Yamikani Chimwaza Alexandra Hunt Livia Oliveira-Ciabati Laura Bonnett Edgardo Abalos Cristina Cuesta João Paulo Souza Mercedes Bonet Vanessa Brizuela David Lissauer Yamikani Chimwaza Alexandra Hunt Livia Oliveira-Ciabati Laura Bonnett Edgardo Abalos Cristina Cuesta João Paulo Souza Mercedes Bonet Vanessa Brizuela David Lissauer Mohammad Iqbal Aman Bashir Noormal Marisa Espinoza Julia Pasquale Charlotte Leroy Kristien Roelens Griet Vandenberghe M. Christian Urlyss Agossou Sourou Goufodji Keke Christiane Tshabu Aguemon Patricia Soledad Apaza Peralta Víctor Conde Altamirano Rosalinda Hernández Muñoz José Guilherme Cecatti Carolina Ribeiro do Valle Vincent Batiene Kadari Cisse Henri Gautier Ouedraogo Kannitha Cheang Phirun Lam Tung Rathavy Elie Simo Pierre-Marie Tebeu Emah Irene Yakana Javier Carvajal María Fernanda Escobar Paula Fernández Lotte Berdiin Colmorn Jens Langhoff-Roos Wilson Mereci Paola Vélez Yasser Salah Eldin Alaa Sultan Alula M. Teklu Dawit Worku Richard Adanu Philip Govule Charles Noora Lwanga William Enrique Arriaga Romero María Guadalupe Flores Aceituno Carolina Bustillo Bredy Lara Vijay Kumar Vanita Suri Sonia Trikha Irene Cetin Serena Donati Carlo Personeni Guldana Baimussanova Saule Kabylova Balgyn Sagyndykova George Gwako Alfred Osoti Zahida Qureshi Raisa Asylbasheva Aigul Boobekova Damira Seksenbaeva Saad Eddine Itani Meilė Minkauskienė Diana Ramašauskaitė Owen Chikhwaza Luis Gadama Eddie Malunga Haoua Dembele Hamadoun Sangho Fanta Eliane Zerbo Filiberto Dávila Serapio Nazarea Herrera Maldonado Juan I. Islas Castañeda Tatiana Cauaus Ala Curteanu Victor Petrov Yadamsuren Buyanjargal Seded Khishgee Bat-Erdene Lkhagvasuren Amina Essolbi Rachid Moulki Zara Jaze Arlete Mariano Nafissa Bique Osman Hla Mya Thway Einda Thae Maung Maung Khaing Nwe Tin Tara Gurung Amir Babu Shrestha Sangeeta Shrestha Kitty Bloemenkamp Marcus J. Rijken Thomas Van Den Akker María Esther Estrada Néstor J. Pavón Gómez Olubukola Adesina Chris Aimakhu Bukola Fawole Rizwana Chaudhri Saima Hamid M. Adnan Khan María del Pilar Huatuco Hernández Nelly M. Zavaleta Pimentel Maria Lu Andal Zenaida Dy Recidoro Carolina Paula Martin Mihaela Budianu Lucian Pușcașiu Léopold Diouf Dembo Guirassy Philippe Marc Moreira Miroslav Borovsky Ladislav Kovac Alexandra Kristufkova Sylvia Cebekhulu Laura Cornelissen Priya Soma-Pillay Vicenç Cararach Marta López María José Vidal Benedé Hemali Jayakody Kapila Jayaratne Dhammica Rowel Wisal Nabag Sara Omer Victoria Tsoy Urunbish Uzakova Dilrabo Yunusova Thitiporn Siriwachirachai Thumwadee Tangsiriwatthana Catherine Dunlop Marian Knight Jhon Roman Gerardo Vitureira Dinh Anh Tuan Luong Ngoc Truong Nghiem Thi Xuan Hanh Mugove Madziyire Thulani Magwali Stephen Munjanja Adama Baguiya Mónica Chamillard Bukola Fawole Marian Knight Seni Kouanda Pisake Lumbiganon Ashraf Nabhan Ruta Nadisauskiene Linda Bartlett Fernando Bellissimo-Rodrigues Shevin T. Jacob Sadia Shakoor Khalid Yunis Liana Campodónico Hugo Gamerro Daniel Giordano Fernando Althabe A. Metin Gülmezoglu |
| author_sort | Yamikani Chimwaza |
| collection | DOAJ |
| description | Summary: Background: Infections and sepsis are leading causes of morbidity and mortality in women during pregnancy and the post-pregnancy period. Using data from the 2017 WHO Global Maternal Sepsis Study, we explored the use of early warning systems (EWS) in women at risk of sepsis-related severe maternal outcomes. Methods: On April 27, 2023, we searched the literature for EWS in clinical use or research in obstetric populations. We calculated the proportion of women for whom each existing EWS identified them as at risk for developing severe maternal outcomes by infection severity (complications and severe maternal outcomes). Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, and J statistics were calculated to assess EWS performance. Machine learning was used to test the diagnostic potential of routine maternal sepsis markers. Findings: 21 EWS were assessed in 2560 women from 46 countries with suspected or confirmed infections. The NICE Risk Stratification tool, Modified Shock Index, maternity Systemic Inflammatory Response Syndrome, and Early Maternal Infection Prompts scores had high sensitivity (88.1–97.5%) for identifying sepsis-related severe maternal outcomes. The quick Sequential Organ Failure Assessment (SOFA) in Pregnancy score and Obstetrically modified SOFA had high specificity (90.4–100%) for identifying women with sepsis-related severe maternal outcomes. Furthermore, combinations of sepsis markers had very low sensitivity and high specificity using machine learning. Interpretation: No score demonstrated enough diagnostic accuracy to be used alone to identify sepsis. However, obstetric—and sepsis-specific EWS performed better for early identification of maternal sepsis than non-obstetric and non-sepsis-specific scoring systems. There are limitations to applying EWS to real-world data, mainly due to the incompleteness of medical data that hinders EWS effectiveness. There is a need to continue developing and testing criteria for early identification of maternal sepsis. Funding: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Merck for Mothers, U.S. Agency for International Development, Wellcome Trust, and National Institute for Health and Care Research. |
| format | Article |
| id | doaj-art-284fa8c8e281462f92c669ea98cf76ba |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-284fa8c8e281462f92c669ea98cf76ba2025-01-22T05:43:15ZengElsevierEClinicalMedicine2589-53702025-01-0179102981Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in contextYamikani Chimwaza0Alexandra Hunt1Livia Oliveira-Ciabati2Laura Bonnett3Edgardo Abalos4Cristina Cuesta5João Paulo Souza6Mercedes Bonet7Vanessa Brizuela8David Lissauer9Yamikani ChimwazaAlexandra HuntLivia Oliveira-CiabatiLaura BonnettEdgardo AbalosCristina CuestaJoão Paulo SouzaMercedes BonetVanessa BrizuelaDavid Lissauer Mohammad Iqbal AmanBashir NoormalMarisa EspinozaJulia PasqualeCharlotte LeroyKristien RoelensGriet VandenbergheM. Christian Urlyss AgossouSourou Goufodji KekeChristiane Tshabu AguemonPatricia Soledad Apaza PeraltaVíctor Conde AltamiranoRosalinda Hernández MuñozJosé Guilherme CecattiCarolina Ribeiro do ValleVincent BatieneKadari CisseHenri Gautier OuedraogoKannitha CheangPhirun LamTung RathavyElie SimoPierre-Marie TebeuEmah Irene YakanaJavier CarvajalMaría Fernanda EscobarPaula FernándezLotte Berdiin ColmornJens Langhoff-RoosWilson MereciPaola VélezYasser Salah EldinAlaa SultanAlula M. TekluDawit WorkuRichard AdanuPhilip GovuleCharles Noora LwangaWilliam Enrique Arriaga RomeroMaría Guadalupe Flores AceitunoCarolina BustilloBredy LaraVijay KumarVanita SuriSonia TrikhaIrene CetinSerena DonatiCarlo PersoneniGuldana BaimussanovaSaule KabylovaBalgyn SagyndykovaGeorge GwakoAlfred OsotiZahida QureshiRaisa AsylbashevaAigul BoobekovaDamira SeksenbaevaSaad Eddine ItaniMeilė MinkauskienėDiana RamašauskaitėOwen ChikhwazaLuis GadamaEddie MalungaHaoua DembeleHamadoun SanghoFanta Eliane ZerboFiliberto Dávila SerapioNazarea Herrera MaldonadoJuan I. Islas CastañedaTatiana CauausAla CurteanuVictor PetrovYadamsuren BuyanjargalSeded KhishgeeBat-Erdene LkhagvasurenAmina EssolbiRachid MoulkiZara JazeArlete MarianoNafissa Bique OsmanHla Mya Thway EindaThae Maung MaungKhaing Nwe TinTara GurungAmir Babu ShresthaSangeeta ShresthaKitty BloemenkampMarcus J. RijkenThomas Van Den AkkerMaría Esther EstradaNéstor J. Pavón GómezOlubukola AdesinaChris AimakhuBukola FawoleRizwana ChaudhriSaima HamidM. Adnan KhanMaría del Pilar Huatuco HernándezNelly M. Zavaleta PimentelMaria Lu AndalZenaida Dy RecidoroCarolina Paula MartinMihaela BudianuLucian PușcașiuLéopold DioufDembo GuirassyPhilippe Marc MoreiraMiroslav BorovskyLadislav KovacAlexandra KristufkovaSylvia CebekhuluLaura CornelissenPriya Soma-PillayVicenç CararachMarta LópezMaría José Vidal BenedéHemali JayakodyKapila JayaratneDhammica RowelWisal NabagSara OmerVictoria TsoyUrunbish UzakovaDilrabo YunusovaThitiporn SiriwachirachaiThumwadee TangsiriwatthanaCatherine DunlopMarian KnightJhon RomanGerardo VitureiraDinh Anh TuanLuong Ngoc TruongNghiem Thi Xuan HanhMugove MadziyireThulani MagwaliStephen MunjanjaAdama BaguiyaMónica ChamillardBukola FawoleMarian KnightSeni KouandaPisake LumbiganonAshraf NabhanRuta NadisauskieneLinda BartlettFernando Bellissimo-RodriguesShevin T. JacobSadia ShakoorKhalid YunisLiana CampodónicoHugo GamerroDaniel GiordanoFernando AlthabeA. Metin GülmezogluMalawi-Liverpool Wellcome Programme, Blantyre, Malawi; Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Corresponding author.Department of Health Data Science, University of Liverpool, Liverpool, United KingdomHealth Innovation Techcenter (HIT), Hospital Israelita Albert Einstein, São Paulo, Brazil; Barão de Mauá University Center, Ribeirão Preto, SP, BrazilDepartment of Health Data Science, University of Liverpool, Liverpool, United KingdomCentro Rosarino de Estudios Perinatales (CREP), Rosario, ArgentinaCentro Rosarino de Estudios Perinatales (CREP), Rosario, ArgentinaDepartment of Social Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, BrazilUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandUNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandMalawi-Liverpool Wellcome Programme, Blantyre, Malawi; Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United KingdomSummary: Background: Infections and sepsis are leading causes of morbidity and mortality in women during pregnancy and the post-pregnancy period. Using data from the 2017 WHO Global Maternal Sepsis Study, we explored the use of early warning systems (EWS) in women at risk of sepsis-related severe maternal outcomes. Methods: On April 27, 2023, we searched the literature for EWS in clinical use or research in obstetric populations. We calculated the proportion of women for whom each existing EWS identified them as at risk for developing severe maternal outcomes by infection severity (complications and severe maternal outcomes). Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, and J statistics were calculated to assess EWS performance. Machine learning was used to test the diagnostic potential of routine maternal sepsis markers. Findings: 21 EWS were assessed in 2560 women from 46 countries with suspected or confirmed infections. The NICE Risk Stratification tool, Modified Shock Index, maternity Systemic Inflammatory Response Syndrome, and Early Maternal Infection Prompts scores had high sensitivity (88.1–97.5%) for identifying sepsis-related severe maternal outcomes. The quick Sequential Organ Failure Assessment (SOFA) in Pregnancy score and Obstetrically modified SOFA had high specificity (90.4–100%) for identifying women with sepsis-related severe maternal outcomes. Furthermore, combinations of sepsis markers had very low sensitivity and high specificity using machine learning. Interpretation: No score demonstrated enough diagnostic accuracy to be used alone to identify sepsis. However, obstetric—and sepsis-specific EWS performed better for early identification of maternal sepsis than non-obstetric and non-sepsis-specific scoring systems. There are limitations to applying EWS to real-world data, mainly due to the incompleteness of medical data that hinders EWS effectiveness. There is a need to continue developing and testing criteria for early identification of maternal sepsis. Funding: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Merck for Mothers, U.S. Agency for International Development, Wellcome Trust, and National Institute for Health and Care Research.http://www.sciencedirect.com/science/article/pii/S2589537024005601Early warning systemsSepsisMaternal sepsisEarly identificationSevere maternal outcome |
| spellingShingle | Yamikani Chimwaza Alexandra Hunt Livia Oliveira-Ciabati Laura Bonnett Edgardo Abalos Cristina Cuesta João Paulo Souza Mercedes Bonet Vanessa Brizuela David Lissauer Yamikani Chimwaza Alexandra Hunt Livia Oliveira-Ciabati Laura Bonnett Edgardo Abalos Cristina Cuesta João Paulo Souza Mercedes Bonet Vanessa Brizuela David Lissauer Mohammad Iqbal Aman Bashir Noormal Marisa Espinoza Julia Pasquale Charlotte Leroy Kristien Roelens Griet Vandenberghe M. Christian Urlyss Agossou Sourou Goufodji Keke Christiane Tshabu Aguemon Patricia Soledad Apaza Peralta Víctor Conde Altamirano Rosalinda Hernández Muñoz José Guilherme Cecatti Carolina Ribeiro do Valle Vincent Batiene Kadari Cisse Henri Gautier Ouedraogo Kannitha Cheang Phirun Lam Tung Rathavy Elie Simo Pierre-Marie Tebeu Emah Irene Yakana Javier Carvajal María Fernanda Escobar Paula Fernández Lotte Berdiin Colmorn Jens Langhoff-Roos Wilson Mereci Paola Vélez Yasser Salah Eldin Alaa Sultan Alula M. Teklu Dawit Worku Richard Adanu Philip Govule Charles Noora Lwanga William Enrique Arriaga Romero María Guadalupe Flores Aceituno Carolina Bustillo Bredy Lara Vijay Kumar Vanita Suri Sonia Trikha Irene Cetin Serena Donati Carlo Personeni Guldana Baimussanova Saule Kabylova Balgyn Sagyndykova George Gwako Alfred Osoti Zahida Qureshi Raisa Asylbasheva Aigul Boobekova Damira Seksenbaeva Saad Eddine Itani Meilė Minkauskienė Diana Ramašauskaitė Owen Chikhwaza Luis Gadama Eddie Malunga Haoua Dembele Hamadoun Sangho Fanta Eliane Zerbo Filiberto Dávila Serapio Nazarea Herrera Maldonado Juan I. Islas Castañeda Tatiana Cauaus Ala Curteanu Victor Petrov Yadamsuren Buyanjargal Seded Khishgee Bat-Erdene Lkhagvasuren Amina Essolbi Rachid Moulki Zara Jaze Arlete Mariano Nafissa Bique Osman Hla Mya Thway Einda Thae Maung Maung Khaing Nwe Tin Tara Gurung Amir Babu Shrestha Sangeeta Shrestha Kitty Bloemenkamp Marcus J. Rijken Thomas Van Den Akker María Esther Estrada Néstor J. Pavón Gómez Olubukola Adesina Chris Aimakhu Bukola Fawole Rizwana Chaudhri Saima Hamid M. Adnan Khan María del Pilar Huatuco Hernández Nelly M. Zavaleta Pimentel Maria Lu Andal Zenaida Dy Recidoro Carolina Paula Martin Mihaela Budianu Lucian Pușcașiu Léopold Diouf Dembo Guirassy Philippe Marc Moreira Miroslav Borovsky Ladislav Kovac Alexandra Kristufkova Sylvia Cebekhulu Laura Cornelissen Priya Soma-Pillay Vicenç Cararach Marta López María José Vidal Benedé Hemali Jayakody Kapila Jayaratne Dhammica Rowel Wisal Nabag Sara Omer Victoria Tsoy Urunbish Uzakova Dilrabo Yunusova Thitiporn Siriwachirachai Thumwadee Tangsiriwatthana Catherine Dunlop Marian Knight Jhon Roman Gerardo Vitureira Dinh Anh Tuan Luong Ngoc Truong Nghiem Thi Xuan Hanh Mugove Madziyire Thulani Magwali Stephen Munjanja Adama Baguiya Mónica Chamillard Bukola Fawole Marian Knight Seni Kouanda Pisake Lumbiganon Ashraf Nabhan Ruta Nadisauskiene Linda Bartlett Fernando Bellissimo-Rodrigues Shevin T. Jacob Sadia Shakoor Khalid Yunis Liana Campodónico Hugo Gamerro Daniel Giordano Fernando Althabe A. Metin Gülmezoglu Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context EClinicalMedicine Early warning systems Sepsis Maternal sepsis Early identification Severe maternal outcome |
| title | Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context |
| title_full | Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context |
| title_fullStr | Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context |
| title_full_unstemmed | Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context |
| title_short | Early warning systems for identifying severe maternal outcomes: findings from the WHO global maternal sepsis studyResearch in context |
| title_sort | early warning systems for identifying severe maternal outcomes findings from the who global maternal sepsis studyresearch in context |
| topic | Early warning systems Sepsis Maternal sepsis Early identification Severe maternal outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024005601 |
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