T.G. DENISOVA^1, 2, A.E. SIDOROV¹, A.A. BADEM², S.S. ZHAMLIKHANOVA¹, T.N. SIDOROVA¹, E.A. DENISOVA¹

 ¹Chuvash State University named I.N. Ulyanov, Cheboksary

²Mari El State University, Yoshkar-Ola

Contact details:

Denisova T.G, MD, Professor, Head of the Department of Pediatrics, Obstetrics and Gynecology

Address: 39 Michmana Pavlova, 428034 Cheboksary, Russian Federation, tel.: +7-905-197-37-07, e-mail: tomadenisova@rambler.ru

The article provides a comprehensive analysis of obstetric sepsis as one of the leading and most serious causes of maternal mortality. The epidemiology of this condition is examined in detail, noting significant disparities between countries with different income levels, which reflects systemic gaps in healthcare organizations.

The pathogenetic mechanisms of sepsis development are thoroughly examined, from local infection to systemic inflammatory response and multiple organ dysfunction. Particular attention is paid to diagnostic challenges associated with physiological changes during pregnancy and the nonspecific nature of early symptoms, which leads to delayed diagnosis.

The article outlines modern treatment principles based on the concept of the «golden hour» and “sepsis bundles” protocols, including immediate empirical antibiotic therapy, infusion support, and surgical debridement of the infection focus. Multilevel prevention strategies are presented, encompassing both global initiatives and in-hospital protocols, as well as individual patient management.

Key words: obstetric sepsis, maternal mortality, systemic inflammatory response, septic shock, early diagnosis, sepsis bundle protocols, infection prevention, multiple organ dysfunction, risk factors, intrapartum prevention.

 REFERENCES

1. Murashko L.E. Analysis of maternal mortality from sepsis. Akusherstvo i ginekologiya, 2019, no. 8, pp. 45–51 (in Russ.).
2. Belokrinitskaya T.E. Prevention of maternal mortality in septic complications. Vestnik RGMU, 2019, no. 4, pp. 112–118 (in Russ.).
3. Baybarina E.N., Gus A.I. Intensive care of sepsis in obstetric practice. Anesteziologiya i reanimatologiya, 2021, no. 3, pp. 56–63 (in Russ.).
4. Sepsis — World Health Organization (WHO), available at: https://www.who.int 2024
5. Belov A.V., Pyregov A.V., Troshin P.V., Priputnevich T.V., Kosinov F.A., Rogachevskiy O.V. et al. Current state of the problem and clinical observation of the treatment of obstetric sepsis caused by pathogens. Akusherstvo i ginekologiya, 2022, no. 4, pp. 164–175 (in Russ.).
6. Radzinskiy V.E. Modern classifications of obstetric sepsis. Meditsinskiy sovet, 2020, no. 5, pp. 78–84 (in Russ.).
7. Gabitova N.A., Kedrova A.G., Zakharova M.A., Belousova T.N., Kucherova O.N. Maternal Sepsis: A New International Definition—New Opportunities to Improve Outcomes. Farmateka, 2022, no. 6, pp. 57–62 (in Russ.). DOI: 10.18565/pharmateca.2022.6.57-62
8. Corticosteroids in Sepsis: An Updated Systematic Review and Meta-Analysis. Crit Care Med, 2018, vol. 46 (9), pp. 1411–1420. DOI: 10.1097/CCM.0000000000003262
9. Abramchenko V.V., Kostyuchek D.F. Modern Approaches to the Diagnosis of Septic Complications in Obstetrics. Akusherstvo i ginekologiya, 2020, no. 5, pp. 34–41 (in Russ.).
10. Klinicheskiye rekomendatsii. Poslerodovyye infektsionnyye oslozhneniya [Clinical guidelines. Postpartum infectious complications], 2024. 86 p.
11. Bauer M.E. Maternal sepsis: epidemiology and management. Curr. Opin. Anaesthesiol, 2020, vol. 33 (3), pp. 321–327.
12. Bowser N.A. Risk factors for maternal sepsis in obstetric patients. Am. J. Obstet. Gynecol, 2021, vol. 224 (2), pp. S345–S346.
13. Petrova A.S. Microbiological monitoring in obstetric sepsis. Antibiotiki i khimioterapiya, 2021, vol. 66, no. 3–4, pp. 12–18 (in Russ.).
14. Gusev E.Yu. Antimicrobial therapy of obstetric sepsis: current recommendations. Klinicheskaya farmakologiya i terapiya, 2022, vol. 31, no. 1, pp. 45–52 (in Russ.).
15. Rogozhina I.E. Immunological aspects of obstetric sepsis. Immunologiya, 2022, vol. 43, no. 1, pp. 112–119 (in Russ.).
16. Edwards S.E. Maternal sepsis: pathophysiology and prevention. Semin Perinatol., 2022, vol. 46 (3), p. 151634.
17. Kulikov A.V. Early diagnosis of septic shock in pregnant women. Akusherstvo i ginekologiya, 2020, no. 6, pp. 23–29 (in Russ.).
18. Zazerskaya I.E. Laboratory markers in the diagnosis of obstetric sepsis. Laboratornaya meditsina, 2020, vol. 15, no. 2, pp. 78–84 (in Russ.).
19. Khan R.W. Diagnostic biomarkers for maternal sepsis: a meta-analysis. Crit. Care Med, 2021, vol. 49 (8), pp. e782–e791.
20. Konovodova E.N. Organization of care for obstetric sepsis. Organizatsiya zdravookhraneniya, 2021, no. 3, pp. 67–74 (in Russ.).
21. Shmakov R.G. Management tactics for septic shock in obstetrics. Akusherstvo i ginekologiya, 2021, no. 9, pp. 23–29 (in Russ.).
22. Serov V.N. Clinical protocols for obstetric sepsis. Akusherstvo i ginekologiya, 2020, no. 7, pp. 34–40 (in Russ.).
23. Kostin I.N. Surgical treatment of septic complications in obstetrics. Khirurgiya, 2022, no. 1, pp. 89–95 (in Russ.).
24. Savel′yeva I.S. Infusion therapy for septic shock in obstetrics. Obshchaya reanimatologiya, 2021, vol. 17, no. 2, pp. 56–63 (in Russ.).
25. Tikhomirov A.L. Antibiotic prophylaxis in obstetrics. Russkiy meditsinskiy zhurnal, 2021, vol. 29, no. 4, pp. 234–239 (in Russ.).
26. Yakovlev S.V. Rational antibiotic therapy of sepsis. Klinicheskaya mikrobiologiya i khimioterapiya, 2020, vol. 22, no. 2, pp. 156–162 (in Russ.).
27. D’Souza R. Management of maternal sepsis in pregnancy: a systematic review. BJOG, 2022, vol. 129 (5), pp. 789–801.
28. Shifman E.M. Cardiohemodynamics in obstetric sepsis. Anesteziologiya i reanimatologiya, 2022, no. 2, pp. 67–73 (in Russ.).
29. Sidorova I.S. Rehabilitation after obstetric sepsis. Vestnik vosstanovitel′noy meditsiny, 2022, no. 1, pp. 45–51 (in Russ.).
30. Smith J.R. Long-term outcomes after maternal sepsis: a cohort study. Lancet, 2021, vol. 397 (10282), pp. 1409–1417.
31. Logutova L.S. Risk factors for the development of obstetric sepsis. Problemy reproduktsii, 2021, vol. 27, no. 4, pp. 34–41.
32. Malyshkina A.I. Neonatal outcomes in obstetric sepsis. Pediatriya, 2022, vol. 101, no. 2, pp. 156–162.
33. Lappen J.R. Maternal sepsis mortality and prevention. Obstet. Gynecol. Surv., 2020, vol. 75 (5), pp. 287–295.
34. Plante L.A. Sepsis bundles in maternal care: implementation and outcomes. Am. J. Obstet. Gynecol. MFM, 2022, vol. 4 (2S). 100612.
35. Joseph D. Forrester. Sepsis and septic shock. Spravochnik MSD. Professional′naya versiya (in Russ.), available at: https://www.msdmanuals.com/ru-ru/professional/медицина-критических-состояний/сепсис-и-септический-шок/сепсис-и-септический-шок?query=forrester#Диагностика_v928482_ru