The presence of fever, bradycardia, cyanosis, lethargy, shortness of breath, and apnoea are the hallmark clinical manifestations of sepsis in newborns and are of significant concern in a neonatal ward [1]. Depending on the temporal occurrence of the clinical picture, a distinction is made between an early form, also called early-onset sepsis (EOS), and a late form, also called late-onset sepsis (LOS) [2,3]. An outbreak of illness within the first seven days after birth is defined as an early onset. However, as the time limit is progressively reduced, the onset of sepsis within the first 72 hours after birth is now commonly classified as an early form. For symptoms manifesting between days 8 and 3 months after birth, the definition of a LOS applies [4,5,6]. While LOS is typically associated with a milder course of the disease, EOS carries a risk of rapid aggravation to multiorgan failure. EOS is significantly more often associated with obstetric complications, such as premature rupture of the bladder, premature labor, chorioamnionitis, or maternal fever subpartu. [7-10]

Neonatal sepsis remains a serious neonatal clinical condition [11]. The definition of (neonatal) sepsis has evolved over time and differs from that applied to adults, particularly in newborns. In the context of neonatal sepsis, it is imperative to differentiate between early-onset sepsis (EOS) and late-onset sepsis (LOS) [12-14]. Early-onset sepsis manifests within the first 72 hours after birth, typically within the first 24 hours, while late-onset sepsis emerges after the first 72 hours of life [15]. The consequences of neonatal sepsis can be serious, including septic shock with a high mortality rate, organ failure, and, as a serious long-term consequence, compromised neurological development of the newborn. [16]

The most significant prenatal risk factor for EOS, affecting approximately 1-5 per 1000 live births, particularly in conjunction with an immature immune system in cases of potential prematurity, is the premature rupture of membranes (vBS) [17]. This results in the restriction of the physical barrier between the unborn and the environment, thereby facilitating germascension. However, the possibility of transplacental or transuterine infection exists, albeit less frequently. Consequently, the amniotic infection syndrome, now recognised as triple I, in conjunction with general maternal infections, should be regarded as a potential threat to the foetus [18]. The maternal anogenital tract is identified as the origin of the pathogens in the majority of cases, thereby explaining the increased occurrence of group B streptococci and Escherichia coli as causative agents of neonatal sepsis, with Escherichia coli, in particular, being associated with higher mortality in EOS. [19,20]

From March 2023 to April 2024, we conducted a cross-sectional study for pregnant women with sepsis who were evaluated at the emergency room of the Women as well as Infants different hospitals in Iraq. Ninety pregnant women between the ages of 20 and 40 had their clinical data registered in order to identify those who were thought to be in high risk for sepsis.

All patients, regardless of gestational age and pregnancy status, enter the hospital through the Women or Infants emergency department, which doubles as an obstetric triage unit as a stand-alone emergency room. Age, body mass index (BMI), gestational duration, and medical comorbidities were among the other mother data that were collected. Fetal tachycardia, that is characterized as a heart rate among more over 160 beats per minute, was one of the fetal data being collected.

ICU hospitalization within 48 hours after presenting to the emergency department was the main result. A composite result such as fetal or neonatal death, respiratory distress syndrome, level III or IV intraventricular hemorrhage, necrotizing enterocolitis, or sepsis within 72 hours of birth was referred to as an adverse perinatal outcome. Other additional results comprised telemetry unit acceptance, the duration of stay in the hospital, death, positive blood cultures, positive influenza swabs, and antibiotic use. Our hospital does not have established criteria for sepsis ICU admission. Nonetheless, patients who fit the criteria in septic shock and need mechanical breathing or a vasopressor are frequently transferred to the intensive care unit.

TABLE 1. BASELINE DEMOGRAPHIC CHARACTERISTICS OF MATERNAL PARTICIPATED IN THIS STUDY.

TABLE 2. VITAL SIGNS AND DIAGNOSTIC DATA FOR PREGNANT WOMEN.

TABLE 3. MATERNAL AND FETAL OUTCOMES.

TABLE 4. EVALUATION OF GENERAL – HEALTH QUALITY OF LIFE AT PATIENTS.

Sepsis, a serious health danger, is a severe immune response to an infection that results in systemic inflammation across the body [21]. The term infection-induced systemic inflammatory reaction syndrome (SIRS) is commonly used to describe this condition. The most common illness at pregnant women that occurs before sepsis is pneumonia, with reproductive system disorders after in second. Incidents of lung inflammation appear to be more prevalent during labor. However, infections from medical treatments or vaginal delivery often show up more after the postpartum period. [22-25]

Infections with Streptococcus species usually cause septic shock sooner than infections with other bacteria [26]. Postpartum individuals are quite more inclined than pregnant women to get particular diseases, especially after delivering birth. [27]

American study [28] also shows that sepsis has a substantial impact on maternal outcomes. 8.3% of instances had oligohydramnios, and 46.67% of patients had caesarean procedures because of unsettling fetal proles. 15% of cases involved preterm premature rupture of the membranes, 11.67% involved intraamniotic infections, 35% involved postpartum hemorrhage, and 3.3% involved postpartum infections. Another study [29] found maternal death was recorded in 1.67% of cases, and 8.3% of patients needed maternal intensive care unit hospitalization at delivery. Sepsis causes respiratory failure that requires intubation for 12% of obstetric patients. 17 Pneumothorax, pericardial tamponade, and atrial fibrillation are among the pregnancy-related problems linked to this infection (4%).

Some study's results [30-33] show how seriously sepsis affects maternal health, resulting in complications that raise the chance of death and the need for sophisticated medical measures. Fetal outcomes are also concerning: 28.33% of neonates are undersized for gestational age, and 5% of cases have intrauterine fetal growth restriction. Preterm delivery happened in 18.33% of cases among 34 and 37 weeks and 26.67% of patients before 34 weeks, with a stillbirth incidence of 3.3%. 15% of babies had a 5-minute APGAR score below 7, and 53.33% of newborns needed to be admitted to the neonatal intensive care unit. The fetal death rate was 3.3%. 

In line with the results of earlier studies [33-35], these figures show a substantial burden of unfavorable fetal outcomes for pregnancies complicated with sepsis, emphasizing the necessity of attentive prenatal care as well as early intervention to minimize risks.

As a major risk factor of adverse fetal outcomes, such as preterm delivery, distress for the baby, intrauterine growth restriction, as well as newborn problems, this study emphasizes the seriousness of sepsis. The findings show the importance it is to identify and treat sepsis at pregnant women as quickly as possible in order to minimize any potential harm to the fetus's health.

The authors declare that they have no conflict of interest

No funding sources

The study was approved by the Diyala University, Diyala Medical College of Medicine, Diyala, Iraq.

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