The care of the fetus and fetal outcomes among patients with PASS is not part of the present review and Galunisertib datasheet has been described elsewhere [25]. Methods Relevant English-language original publications were sought through search of PubMed and EMBASE (from January 1992 through March 2014), using the following key terms: sepsis, severe sepsis, septic shock, septicemia, organ failure, critical illness, critical care, intensive care, mortality and pregnancy, abortion, delivery, puerperium, and miscarriage. Identified citations were further searched for additional referenced citations. The following publication categories were excluded: (a) published only in an abstract form, (b) contained no original data, or (c) did not specifically

describe a group of patients with severe sepsis associated with pregnancy (i.e., at the minimum, the number of

affected patients, with or without other characteristics), either as primary or additional focus of Protease Inhibitor Library order the report. The search strategy is described in detail in the Electronic Supplementary Material. Following removal of duplicate citations, 4,718 articles were identified, of which 4,710 did not meet eligibility criteria [reviews (322), reports on fetal/newborn events (1,933), case reports (743), and lack of specific description of maternal severe sepsis (1,712)]. The remaining eight full-text articles were the focus of the present review. Descriptive statistics were used. This article does not involve any new studies with human or animal subjects performed by the author. The Epidemiology of Pregnancy-Associated Severe Sepsis The key characteristics of identified studies providing epidemiological data on PASS are presented in Table 1. Several single-center and regional studies have reported the incidence of PASS. Mabie et al. [27] reported the incidence of pregnancy-associated septic shock of 12 per 100,000 deliveries-years in a two-hospital study. In a regional study, including 25 hospitals in the United Kingdom (UK) reported by Waterstone et al. [28], the incidence of PASS click here was 35 per 100,000 deliveries-years.

Finally, a study of PASS in a tertiary center in Scotland by Acosta et al. [29] found an incidence of PASS 13 per 100,000 maternities-years. All three studies employed contemporary definitions of severe sepsis. Their findings have, however, several limitations. Data from local facilities may not reflect the epidemiology in a broader population. In addition, the sample size was extremely small, being 18 patients [27], 17 patients [28], and 14 patients [29], affecting precision of overall and annual [29] incidence estimates. Moreover, the reported incidence data were spread over 11 years [27] and 23 years [29], during which the development of PASS and obstetric practice have likely changed. In addition, the last two studies [28, 29] may have underestimated the number of PASS events, due to a restriction of case definition to culture-positive patients.