--- title: "Performance Sepsis Screening Antepartum and Postpartum | Sutter Health" description: "Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions" url: "https://www.sutterhealth.org/research/publications/performance-sepsis-screening-antepartum-postpartum-1055312962" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Performance Sepsis Screening Antepartum and Postpartum # Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions Bauer ME, Fuller M, Kovacheva V, & et al. Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions. _Obstet Gynecol. Published online December 12_ _2023\. doi:10.1097/AOG.0000000000005480_ 2023-12-12 ## Abstract Objective:To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions. Methods:This was a case-control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non-pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion. Results:We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non-pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87-0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9-94.4%) but also had the highest false-positive rates (30.4-63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9-10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum. Conclusion:For admissions early in pregnancy and more than 3 days postpartum, non-pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. The overall false-positive rate remained high. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/38086052/) ![Sylvia Sudat, Ph.D.](https://dyn.mktgcdn.com/p/2AHRaDJwevdbwzC2ecrwY3nYIxbiqxd9NbpxBlI8Kpk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Sylvia Sudat, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/sylvia-sudat-phd-1049681027) ## Research topics - [Maternal and Infant Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Maternal+and+Infant+Health%5C%22%22) - [Obstetrics and Gynecology](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Obstetrics+and+Gynecology%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Performance Characteristics of Sepsis Screening Tools During Delivery Admissions](https://www.sutterhealth.org/research/publications/performance-of-sepsis-screening-delivery-admissions-1055312694) Main EK, Fuller M, Kovacheva VP, et al. Performance Characteristics of Sepsis Screening Tools During Delivery Admissions Obstet Gynecol. Published online December 12 2023\. doi:10.1097/AOG.0000000000005477 2023 Dec 12 - Publication ### [An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis.](https://www.sutterhealth.org/research/publications/surgical-vs-clinical-dx-of-endometriosis-1055312364) Taylor HS, Adamson GD, Diamond MP, Goldstein SR, Horne AW, Missmer SA, Snabes MC, Surrey E, Taylor RN. Int J Gynaecol Obstet. 2018 May 5. doi: 10.1002/ijgo.12521. \[Epub ahead of print\] Review. 2018 May 05 - Publication ### [International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.](https://www.sutterhealth.org/research/publications/world-report-on-assisted-reproductive-technology-2011-1055312366) Adamson GD, de Mouzon J, Chambers GM, Zegers-Hochschild F, Mansour R, Ishihara O, Banker M, Dyer S. Fertil Steril. 110(6):1067-1080. doi: 10.1016/j.fertnstert.2018.06.039. 2018 Nov 01 - Publication ### [The International Glossary on Infertility and Fertility Care, 2017.](https://www.sutterhealth.org/research/publications/internatl-glossary-infertility-fertility-care-1055312335) Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, Rienzi L, Sunde A, Schmidt L, Cooke ID, Simpson JL, van der Poel S. Fertil Steril. pii: S0015-0282(17)30429-6. doi: 10.1016/j.fertnstert.2017.06.005. \[Epub ahead of print\] 2017 Jul 28 - Publication ### [Revisiting the Table 2 fallacy: A motivating example examining preeclampsia and preterm birth.](https://www.sutterhealth.org/research/publications/revisit-table-2-fallacy-preeclampsia-and-preterm-birth-1055312379) Bandoli G, Palmsten K, Chambers CD, Jelliffe-Pawlowski LL, Baer RJ, Thompson CA. Paediatr Perinat Epidemiol. doi: 10.1111/ppe.12474. \[Epub ahead of print\] 2018 May 21 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/performance-sepsis-screening-antepartum-postpartum-1055312962#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Performance Sepsis Screening Antepartum and Postpartum"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/performance-sepsis-screening-antepartum-postpartum-1055312962#medicalscholarlyarticle","name":"Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions","headline":"Performance Sepsis Screening Antepartum and Postpartum","abstract":"Objective:To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions. Methods:This was a case-control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non-pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion. Results:We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non-pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87-0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9-94.4%) but also had the highest false-positive rates (30.4-63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9-10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum. Conclusion:For admissions early in pregnancy and more than 3 days postpartum, non-pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. 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