Local reports [27–29], as well as a national study [30] did

not provide clinical details on chronic illness. The population-based study by Acosta et al. [32] documented only occurrence of diabetes and chronic hypertension among live birth PASS hospitalizations. Bauer et al. [33] reported a broader but still selective range of chronic comorbidities, with the most common being congestive heart failure (6%), systemic lupus (1.5%), and chronic liver disease (0.7%). However, the investigators provided no data on the overall frequency of any chronic comorbidity (of those examined) among PASS hospitalizations, limiting the inference on the overall burden of chronic illness from their findings. Risk factors for the development of PASS were examined in several reports. Reported risk factors included maternal MK2206 age ≥35 years [30, 33], low income [30], black race [32, 33], Medicaid insurance [33] or public insurance/no RG-7204 insurance [32], tobacco use [28] congestive heart failure [33], diabetes [32], hypertension [32], chronic liver disease [33], chronic kidney disease [33], systemic

lupus [33], human immunodeficiency viral infection [33], preeclampsia [28, 32], induced labor [29, 30], cesarean section [28–30], premature rupture of membranes [30, 33], and retained products of conception [33]. Of note, obesity was not an independent risk factor for PASS in the study by Bauer et al. [33], possibly due to its underreporting (1.8%) in their population. The aforementioned predictors identify subsets of obstetric patients requiring extra vigilance for

prevention, early recognition and intervention for PASS. However, as noted by others, the risk factors for maternal sepsis are not well-understood [36]. Clinical Manifestations of Pregnancy-Associated Severe Sepsis The most common sites of infection among patients with PASS in local studies were described variably as involving the genital (39%) [27] and urinary (37%) [35] tracts. Kramer et al. [30] reported in their national study that genital tract infections were the most common, noted in 56% of their patients. No data on sites of infection were reported on PASS hospitalizations in the study by Acosta et al. [32]. Finally, in the national population Forskolin study by Bauer et al. [33], the genital tract was the most common reported site of infection (56.7%) among PASS hospitalizations. Of note, pneumonia was reported in 29.7% of PASS hospitalizations [33]. Although SIRS has been considered part of the bedside definition of sepsis in the general population, it was not validated in obstetric patients pre- or post-delivery and multiple investigators have raised concerns about the appropriateness of its cutoff values, which are often observed among otherwise healthy pregnant women [25]. The clinical findings of PASS include those related to a specific site of infection. Nevertheless, the site of infection is often not readily apparent in these patients.