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Jerry J. Zimmerman, MD, PhD, FCCM
While representing the cutting edge of civilization everywhere, mothers and their newborn infants are a population particularly vulnerable to sepsis.1 By recognizing the importance of antiseptic prophylaxis (handwashing), Ignaz Semmelweis directly confronted this particular human sepsis vulnerability and simultaneously codified maternal/ neonatal sepsis and infection prevention. Accordingly he has been hailed as the “Defender of Motherhood.”2 However, despite this seminal discovery nearly 170 years ago, maternal/neonatal sepsis remains a significant global health challenge.
Maternal sepsis has been defined as life-threatening organ dysfunction resulting from infection during pregnancy, during childbirth, post-abortion, or postpartum.3 This definition of maternal sepsis expresses the thinking embedded in the 2016 Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).4 Such infections are responsible for approximately 11% of maternal deaths and increase the risk of early neonatal sepsis.5,6 Moreover, while early neonatal sepsis causes about 8% of all neonatal deaths, the proportion of late neonatal deaths attributable to sepsis is fourfold higher.7 Sepsis may contribute to up to 100,000 maternal deaths annually, and it kills more than 1 million newborns annually. Moreover, it has been emphasized that maternal/neonatal infection reflects much broader concerns that include inadequate public health infrastructure, lack of preventive interventions, scarcity of quality care, and inadequate early diagnosis and infection treatment.
Accordingly, the Global Maternal and Neonatal Sepsis Initiative (srhr.org/sepsis/resources) was launched in 2009 with the goal of accelerating the reduction of preventable maternal and neonatal deaths related to sepsis.8 This World Health Organization (WHO) and Jhpiego (Johns Hopkins Program for International Education in Gynecology and Obstetrics) initiative stresses that every pregnant or recently pregnant woman and newborn is at risk for infection, and that if infection is recognized and treated early, the transition to life-threatening sepsis can be avoided. The initiative has received broad international support from organizations such as the Surviving Sepsis Campaign, a joint collaboration of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM).9 The Global Maternal and Neonatal Sepsis Initiative promotes three objectives:
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