Prevention, early recognition and management of maternal infections and sepsis

Ahmed, Sheikh Irfan ORCID: https://orcid.org/0000-0002-8391-8559 (2024). Prevention, early recognition and management of maternal infections and sepsis. University of Birmingham. Ph.D.

Preview

Ahmed2024PhD.pdf Text Available under License All rights reserved. Download (8MB) | Preview

Abstract

Introduction:
Maternal sepsis is the 3rd leading cause of maternal mortality globally. Sepsis is the second most frequent abortion related complication in low- and middle-income countries. Infection after miscarriage is a serious problem and can cause death and disability. This thesis evaluates the effectiveness of routine antibiotic prophylaxis in surgical management of miscarriage (Aim 1) and describes the implementation and evaluation of FAST-M bundle care tools (MEOWS chart, decision tool, and FAST-M treatment bundle) in a low-resource setting within Pakistan (Aim 2). FAST-M, a bundle developed in collaboration with the WHO and validated in Africa, consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). FAST-M intervention aims to improve the recognition and management of maternal sepsis; it has not yet been validated in Asia.

Methods: Two studies were undertaken as part of this PhD research. (1) A systematic review was conducted to synthesise the effectiveness of routine antibiotic prophylaxis in individuals undergoing uterine evacuation procedures to treat miscarriage (Aim 1). (2) A feasibility study with sequential mixed method intervention design was conducted in women with suspected maternal sepsis admitted at the LUMHS hospital Hyderabad in Pakistan to evaluate the outcomes of FAST-M intervention. Qualitative data was collected in the first phase for the adaptation of FAST-M bundle care tools. This was then followed by the implementation of contextual-based modified tools in the study setting. The implementation outcomes were evaluated using both the quantitative and qualitative methods to validate the study findings. Quantitative comparisons were drawn before and after the implementation to distinguish study outcomes (Aim 2).

Results: Study 1: Six studies with a total of 4371 participants undergoing uterine evacuation procedures to treat miscarriage were included in our review. A metanalysis restricted to studies with low risk of bias (3 trials with 3737 participants, 85% of total participants;) found a 43% reduction in the risk of developing a uterine infection (pooled RR 0.57, 95% CI 0.37 to 0.86, I² = 0%, high certainty evidence). Study 2: Following the FAST-M intervention, significant changes were observed. Improvements were seen in the monitoring of oxygen saturation measurements [25.5% vs 100%; difference: 74%; 95% CI:68.4%-80.5% p<0.01], fetal heart rate assessment [58% vs100%; difference:42.0%; 95% CI: 33.7% to 50.3%; p=<0.01], and measurement of urine output [76.5% vs 100%; difference 23.5%; 95%CI: 17.6% to 29.4%; p<0.01]). An additional improvement in overall patient monitoring was reported by the HCPs in the qualitative study. Women with suspected maternal sepsis received all components of the treatment bundle within one hour of sepsis recognition [0% vs70.5%; difference 70.5%; 95%CI: 60.4% to 80.6%; p<0.01]. The healthcare providers’ views were positive about the intervention, its outcomes, and long-term sustainability.

Conclusion:
The systematic review ascertained a significant reduction in the risk of uterine infection rates with antibiotic prophylaxis during surgery to treat miscarriage based on three trials assessed to have low risk of bias included in the meta-analysis. This PhD research also demonstrated that the implementation of the FAST-M intervention was feasible and significantly improved the quality of maternal sepsis care, including enhanced early identification and management of maternal sepsis.

Type of Work:	Thesis (Doctorates > Ph.D.)
Award Type:	Doctorates > Ph.D.
Supervisor(s):	Supervisor(s) Email ORCID Lissauer, David UNSPECIFIED orcid.org/0000-0002-7878-2327 Coomarasamy, Arri UNSPECIFIED orcid.org/0000-0002-3261-9807
Licence:	All rights reserved
College/Faculty:	Colleges (former) > College of Medical & Dental Sciences
School or Department:	Institute of Metabolism and Systems Research
Funders:	Other
Other Funders:	University of Birmingham, Aga Khan University, National Institute for Health Research (NIHR, WHO Eastern Mediterranean Hub (AKU) of HRP Alliance for Research Capacity Development in Sexual and Reproductive Health
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RG Gynecology and obstetrics
URI:	http://etheses.bham.ac.uk/id/eprint/14711

Actions

	Request a Correction
	View Item

Downloads