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Maternal Physiologic Parameters in Relationship to Systemic Inflammatory Response Syndrome Criteria: A Systematic Review and Meta-analysis

Bauer, Melissa E. DO; Bauer, Samuel T. MD; Rajala, Baskar MBBS; MacEachern, Mark P. MLIS; Polley, Linda S. MD; Childers, David MA; Aronoff, David M. MD

doi: 10.1097/AOG.0000000000000423
Contents: Review

OBJECTIVE: To establish the normal maternal range in healthy pregnant women for each component of the systemic inflammatory response syndrome (SIRS) criteria and compare these ranges with existing SIRS criteria.

DATA SOURCES: PubMed, Embase, and databases were searched to identify studies of healthy parturients from the first trimester through 12 weeks postpartum that reported maternal temperature, respiratory rate, PaCO2, heart rate, white blood cell count data, or a combination of these.

METHODS OF STUDY SELECTION: Data were extracted from studies providing maternal values for components of SIRS criteria. The mean, standard deviation, and two standard deviations from the mean for all criteria parameters published in the literature were reported.

TABULATION, INTEGRATION, AND RESULTS: Eighty-seven studies met inclusion criteria and included 8,834 patients and 15,237 data points: temperature (10 studies and 2,367 patients), respiratory rate (nine studies and 312 patients), PaCO2 (12 studies and 441 patients), heart rate (39 studies and 1,374 patients), and white blood cell count (23 studies and 4,553 patients). Overlap with SIRS criteria occurred in healthy pregnant women during the second trimester, third trimester, and labor for each of the SIRS criteria except temperature. Every mean value for PaCO2 during pregnancy (and up to 48 hours postpartum) was below 32 mm Hg. Two standard deviations above the mean for temperature, respiratory rate, and heart rate were 38.1°C, 25 breaths per minute, and 107 beats per minute, respectively.

CONCLUSION: Current SIRS criteria often overlap with normal physiologic parameters during pregnancy and the immediate postpartum period; thus, alternative criteria must be developed to diagnose maternal sepsis.

Normal maternal physiologic parameters overlap with criteria used to diagnose sepsis; thus, alternative criteria must be developed to help aid in diagnosis of maternal sepsis.Supplemental Digital Content is Available in the Text.

Department of Anesthesiology, Division of Obstetric Anesthesiology, and the Taubman Health Sciences Library, University of Michigan Health System, and the Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, and the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan; and the Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.

Corresponding author: Melissa E. Bauer, DO, 1500 East Medical Center Drive, SPC 5278, Neuroscience Hospital, L3627, Ann Arbor, MI 48109-5278; e-mail:

Supported by the Burroughs Wellcome Fund Investigators in the Pathogenesis of Infectious Disease Award (D. Aronoff), Global Alliance to Prevent Prematurity and Stillbirth (D. Aronoff), and the University of Michigan Department of Anesthesiology.

The authors thank George Mashour, MD, PhD (Professor of Anesthesiology, Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan) and Robert P. Lorenz, MD (Division of Maternal Fetal Medicine, William Beaumont Hospital, Royal Oak, Michigan) for reviewing the manuscript. The authors also thank Kristina Priessnitz, BS, and Sydney Behrmann, BS (research assistants, funded by the Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan) for their assistance with organization, management, and formatting of this systematic review.

Presented in part at the annual meeting for the Society for Obstetric Anesthesia and Perinatology, May 14–18, 2014, Toronto, Ontario, Canada.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.