Global incidence of maternal sepsis: A systematic review and meta-analysis.

Summary

Across 44 studies including over 141 million pregnancies, the pooled global incidence of maternal sepsis was 13.16 per 10,000 pregnancies. Incidence varied markedly by region (highest in Africa, lowest in the Americas), and risk factors included age ≥35, multiple gestation, obesity, diabetes, hypertensive disorders including preeclampsia/eclampsia, gestational diabetes, and cesarean delivery.

Key Findings

• Pooled global incidence: 13.16 per 10,000 pregnancies (95% CI 9.91–17.47).
• Regional extremes: Africa 129.17 per 10,000 (95% CI 67.05–248.85) vs. Americas 6.31 per 10,000 (95% CI 4.36–9.12).
• Risk factors: age ≥35, multiple pregnancy, obesity, diabetes (including gestational), hypertensive disorders/preeclampsia–eclampsia, and cesarean delivery.

Clinical Implications

Supports risk-based screening and prevention (e.g., optimized perioperative prophylaxis for cesarean, hypertensive disorder management, and infection surveillance) and prioritization of resources in high-burden regions.

Limitations

• Substantial regional heterogeneity and uneven study distribution (fewer African studies).
• Variable definitions and ascertainment of maternal sepsis may introduce bias.

Future Directions

Standardize definitions and surveillance, expand high-quality data from underrepresented regions, and evaluate implementation strategies that reduce maternal sepsis burden.