Finally, the incidence figures of these three studies are overstated in part due to use of delivery and maternity denominators in patients with PASS Epigenetics inhibitor in the context of all pregnancy outcomes (i.e., abortion), rather than the total number of pregnancies among women at risk during study period. Table 1 Key characteristics of studies providing epidemiological data on pregnancy-associated severe sepsis References Years of study Type/Country Number of patients Scope of pregnancy outcomes Mabie et al. [27] 1986–1997 Local/US 18 All Waterstone et al. [28] 1997–1998

Regional/UK 17 All deliveries after 24 weeks of gestation Acosta et al. [29] 1986–2008 Local/UK 14 All Kramer et al. [30] 2004–2006 National/Netherlands 78 All Acosta et al. [32] 2005–2007 State/US 791a Live birth hospitalizations Bauer et al. [33] 1998–2008 National/US 4,158a Delivery hospitalizations UK United Kingdom, US United States aNumber of hospitalizations Three population-level studies on PASS have been recently reported. Kramer et al. [30] have performed a retrospective analysis of a prospective national cohort in the Netherlands on severe maternal morbidity. The incidence of PASS was 21 per 100,000 deliveries-years. However, the validity of this estimate is limited by numerous methodological Selleckchem Afatinib problems. There has been no explicit definition of sepsis, and severe

sepsis was defined in part by admission to an ICU or any case of (an undefined) sepsis a physician considered to be severe morbidity. Specific OF/dysfunction criteria were not used, which may have led to misclassification and overestimation of PASS incidence, as not all ICU admissions with an tuclazepam infection are due to severe sepsis. Indeed, as noted in a report by Afessa et al. [31], studying obstetric patients in the ICU, among all obstetric sepsis

patients admitted to the ICU, 49% did not have severe sepsis, when the authors used the consensus definitions [1]. In addition, as acknowledged by the investigators, sepsis was not a pre-defined condition for the prospective data collection, leading to possible underestimation of PASS events [30]. The number of PASS patients was only 78, limiting further the precision of incidence estimates. Finally, although PASS events spread over all pregnancy outcomes, the denominator used for incidence estimates was the number of deliveries which, as noted above, may have overestimated the actual incidence. A more recent study by Acosta et al. [32] examined administrative data of live birth hospitalizations in the state of California. The reported incidence of PASS was 49 hospitalizations per 100,000 live births-years. The investigators included hospital length of stay ≥90th percentile and/or admission to ICU as part of case definition of severe sepsis, while not including OF criteria.