Association of Pregnancy-Adjusted Sepsis Screening Criteria with Risk of Maternal Infectious Morbidity in the Setting of Intrapartum Intraamniotic Infection

Abstract

Objective

The California Maternal Quality Care Collaborative (CMQCC) developed a pregnancy-adjusted sepsis screen that includes temperature ≥100.4°F, heart rate > 110 bpm, respiratory rate > 24 bpm, and white blood cell count > 15,000/mm³. This tool was not validated in the intrapartum state. We aim to evaluate the performance of the first part of the CMQCC sepsis screen to identify infection-related morbidity in patients diagnosed with intraamniotic infection.

Study Design

A retrospective cohort study was performed of 541 patients diagnosed with suspected intraamniotic infection prior to delivery at a single center from July 2017 to June 2021. The primary outcome was composite maternal infectious morbidity (end-organ injury, bacteremia, intensive care unit admission, postpartum endometritis, postpartum readmission for infection, or maternal death) in birthing people who screened positive (two or more CMQCC sepsis screen criteria) compared with those who screened negative. Binary logistic multivariable regression was performed with backward selection including overall sepsis screen results as well as individual screening criteria. Data presented as odds ratio (OR) with a two-sided p-value of 0.05 was used for significance.

Results

Of the 541 reviewed cases, 336 (62%) screened positive while 205 (38%) screened negative. Birthing people with a positive sepsis screen in labor had a higher rate of composite maternal infectious morbidity compared with those with a negative screen, although this did not reach statistical significance (17.6% vs. 11.7%; p = 0.07; OR: 1.6 [0.96–2.68]). In evaluating individual criteria, heart rate > 110 bpm (p = 0.003; OR: 2.1 [1.3–3.4]) and respiratory rate > 24 bpm (p = 0.039; 5.7 [1.09–29.8]) were significantly associated with composite maternal infectious morbidity.

Conclusion

Most birthing people with intraamniotic infection screen positive prior to delivery using the CMQCC sepsis screen. When looking at the sepsis screen's individual components, elevated heart rate and respiratory rate may be useful in identifying those at increased risk of infectious morbidity.

Key Points

• Most patients with intraamniotic infection screen positive prior to delivery using the CMQCC screen.

• The overall CMQCC sepsis screen was not associated with infectious morbidity.

• Elevated heart rate and respiratory rate may identify those at increased risk of morbidity.

Keywords

sepsis - intraamniotic infection - CMQCC

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