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Table 1 Summary of definitions used to refer to maternal sepsis in studies, guidelines and WHO documents included in the systematic review

From: Towards a consensus definition of maternal sepsis: results of a systematic review and expert consultation

Name of organization proposing the definition, (year) Definition Studies referring to the definition Guidelines referring to the definition
American College of Chest Physicians and the Society of Critical Care Medicine (1992) [17] Systemic inflammatory response syndrome (SIRS): Widespread inflammatory response to severe clinical insult defined by the presence of two or more of the following symptoms:
Temperature >38 °C or <36 °C
Heart rate >90/min
Respiratory rate >20/min or PaCO2 < 32 mmHg
White blood cells >12 × 10^9/dL or <4 × 10^9/dL or >10% immature forms
Sepsis: SIRS plus definitive evidence of infection
Severe sepsis: Sepsis with signs of organ dysfunction, hypoperfusion or hypotension
Septic shock: Sepsis with hypotension despite adequate fluid resuscitation
Barton, 2012 [10]; Buddeberg, 2015 [4]; Chebbo, 2016 [22]; Cordioli, 2013 [23]; Frise, 2015 [26]; Morgan, 2013 [5]; Oud [35] Pacheco, 2014 [36]; van Dillen, 2010 [12] FLASOG 2013 [47]
International Classification of Diseases, Revision 10 (ICD-10) (1994) A temperature rise above 100.4 F (38 °C) maintained over 24 h or recurring during the period from the end of the first to the end of the 10th day after childbirth or abortion. Acosta, 2013 [2]; Bamfo, 2013 [21]; van Dillen, 2010 [12]; Hashmi, 2014 [29]; Sung, 2011 [39] -
SCCM/ESICM/ACCP/ATS/SIS
International Sepsis Definitions Conference 2001 (2003) [18]
Refers to American College of Chest Physicians and the Society of Critical Care Medicine (1992) definition as above with expanded list of criteria. Arulkumaran, 2013 [20]; Hashmi, 2014 [29] CEC 2015 [45]; HSE 2014 [43]; NICE 2016 [42]; South Australian Perinatal Practice Guidelines 2014 [44]; RCOG 2011 [41]; RCOG 2012 [13]
The prevention and management of puerperal infections
World Health Organization (WHO)
(1992) [48]
Puerperal sepsis is an infection of the genital tract occurring at any time between the rupture of membranes or labour and the 42nd day postpartum, in which, two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge and delay in the reduction of the size of the uterus Acosta, 2013 [2]; Buddeberg, 2015 [4]; Bamfo, 2013 [21]; Karsnitz, 2013 [30]; Lamy [31] Lucas, 2011 [33]; van Dillen, 2010 [12]; Hashmi, 2014 [29]; Sung, 2011 [39] -
Managing Complications in
Pregnancy and Childbirth:
A guide for midwives and doctors
WHO (2003) [50]
Infection can result in failure of the circulatory system to maintain adequate perfusion of the vital organs (shock). Suspect or anticipate shock if at least one of the following is present: fast weak pulse (110 per minute or more), low blood pressure (systolic less than 90 mmHg), sweatiness or cold clammy skin, rapid breathing (rate of 30 breaths or more), anxiousness, confusion or unconsciousness, scanty urine output (less than 30 ml per hour), other symptoms and signs of shock include: pallor (specially of inner eyelid, palms or around mouth).
Septic abortion: an abortion complicated with infection. Sepsis may result from infection if organisms rise from the lower genital tract following either spontaneous or unsafe abortion. Symptoms and signs are: lower abdominal pain, rebound tenderness, tender uterus, prolonged bleeding, malaise, fever, foul-smelling vaginal discharge, purulent cervical discharge, cervical motion tenderness
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Midwifery education modules –
Managing puerperal sepsis
(WHO) (2008) [49]
Puerperal sepsis is any bacterial infection of the genital tract which occurs after the birth of a baby. The following symptoms and signs occur in puerperal sepsis: fever (temperature of 38 °C or more), chills and general malaise, lower abdominal pain, tender uterus, subinvolution of the uterus, purulent, foul-smelling lochia. Symptoms and signs that may also be present: light vaginal bleeding, shock
Septic abortion: An abortion (loss of pregnancy during the first 22 weeks) that is followed by infection of the uterus and may spread throughout the genital tract causing fever and chills, foul-smelling vaginal discharge, pelvic pain and septicaemia
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  1. ACCP American College of Chest Physicians, ATS American Thoracic Society, ESICM European Society of Intensive Care Medicine, SCCM Society of Critical Care Medicine, SIS Surgical Infection Society