Burden of puerperal sepsis and its relation with maternal mortality

Authors

  • Harpreet Kaur Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
  • Sarvjeet Kaur Department of Anesthesiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
  • Sheena Mattu Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
  • Anchal Nandrajog Department of Obstetrics and Gynecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20232955

Keywords:

Morbidity, Mortality, Puerperal sepsis, Surgery

Abstract

Background: Puerperal sepsis, an infection of the genital tract, can appear at any time between the time of membrane rupture or labour to 42nd day after delivery. It accounts for 15% of maternal mortality. Aims of this study are to determine the incidence of puerperal sepsis and the associated mortality rate and explore socioeconomic risk factors of puerperal sepsis.

Methods: This prospective longitudinal study was conducted in Obstetrics and Gynecology department at the GGSMC and H, Faridkot, from November 2021 to October 2022. Inclusion criteria were: any patient presenting either immediately after delivery/abortion or within 42 days of these events with fever and any of the following: abdominal pain, malodorous lochia, abdominal distention, uterine tenderness, pelvic abscess, peritonitis, mechanical or foreign body injury, organ failure, or shock.

Results: The incidence of puerperal sepsis among the women was 6.37 per 100 population at-risk in our study sample. Laparotomies were performed on 17 patients, primarily because to abdominal collection. Four patients experienced uterine perforation, and one of them also had gastrointestinal injury. The maternal deaths attributed to puerperal sepsis were 19.2%.

Conclusions: The morbidity and mortality of women from puerperal sepsis are indicators of the quality of obstetric care in the area. The incidence of maternal sepsis may be reduced with the support of initiatives to encourage early recognition and effective therapy. Future study must focus on exploring the causes of anaemia and the factors that influence women going to unsafe delivery and abortions, so that evidence-based policies at the community level.

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References

Hussein J, Walker L. Puerperal sepsis in low and middle income settings: past, present and future. Mat Infant Deaths J. 2010;4:131-47.

Gomes M, Begum R, Sati P, et al. Nationwide mortality studies to quantify causes of death: Relevant lessons from India’s million death study. Health Aff. 2017;36(11):1887-95.

World Health Organization. Statement on Maternal Sepsis. Available at: https://www.who.int. Accessed on 20 February 2023.

Acosta CD, Harrison DA, Rowan K, Lucas DN, Kurinczuk JJ, Knight M. Maternal morbidity and mortality from severe sepsis: a national cohort study. BMJ. 2016;6(8):e012323.

Bion J, Jaeschke R, Thompson BT, Levy M, Dellinger RP. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34(6):1163-4.

Jain A, Jain MK, Jain P, Jain AK. Efficacy and safety of perrectal 400 microgram misoprostol versus intravenous 200 microgram methylergometrine in the management of third stage of labor for prevention of postpartum haemorrhage. Int J Health Sci. 2022;3: 12185-95.

Fernández-Pérez ER, Salman S, Pendem S, Farmer JC. Sepsis during pregnancy. Crit Care Med. 2005;33(10): S286-93.

Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe SJ, Hoffman BL, et al. William’s obstetrics: Hypertensive disorders. 24th ed. USA: Mcgraw Hill: 2014;728-79.

Madhudas C. O417 maternal morbidity and mortality associated with puerperal sepsis. Int J Gynaecol Obstet. 2012;119:S408.

Hooja N. Evaluation of factors related to labour in women with puerperal sepsis. Int J Pregnancy Child Birth. 2017;3(1):52-8.

Rastogi A. Puerperal sepsis. Nat Health J India. 2016; 32:23-9.

Prakash A, Swain S, Seth A. Maternal mortality in India: current status and strategies for reduction. Indian Pediatr. 1991;28(12):1395-400.

Desai R, Bhati I. Unsafe abortion in the twenty-first century. Acta Obstet Gynecol Scand. 2014;93(5):521-2.

Rocca CH, Puri M, Dulal B. Unsafe abortion after legalisation in Nepal: a cross-sectional study of women presenting to hospitals. BJOG. 2013;120(9):1075-83.

Van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010;23(3):249-54.

Ahmed MI, Alsammani MA, Babiker RA. Puerperal sepsis in a rural hospital in Sudan. Mater Sociomed. 2013;25(1):19-22.

Hussein J, Walker L. Puerperal sepsis in low and middle income settings: past, present and future. Mat Infant Deaths J. 2010;4:131-47

Keralem ABY, Sharew E, Bewket Y, Aynalem L. Addisu Andualem Ferede, Yibelu Bazezew Bitewa, Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study. Front Global Women’s Health. 2023;4: 12-6.

Marwah S, Topden SR, Sharma M, Mohindra R, Mittal P. Severe Puerperal Sepsis-A Simmering Menace. J Clin of Diagn Res. 2017;11(5):QC04-8.

Shamshad S, Shamsher S, Rauf B. Puerperal sepsis-still a major threat for parturient. J Ayub Med Coll Abbottabad. 2010;22(3):18-22.

Khaskheli MN, Baloch S, Sheeba A. Risk factors and complications of puerperal sepsis at a tertiary healthcare centre. Pak J Med Sci Q. 2013;29(4):972-6.

Ngoc NTN, Sloan NL, Thach TS, Liem LKB, Winikoff B. Incidence of postpartum infection after vaginal delivery in Viet Nam. J Health Popul Nutr. 2005; 23(2):121-30.

Hussein J, Ramani KV, Kanguru L, et al. The effect of surveillance and appreciative inquiry on puerperal infections: a longitudinal cohort study in India. PLoS One. 2014;9(1):e873-8.

Knowles SJ, O’Sullivan NP, Meenan AM, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG. 2015;122(5):663-71.

Al-Ostad G, Kezouh A, Spence AR, Abenhaim HA. Incidence and risk factors of sepsis mortality in labor, delivery and after birth: population-based study in the USA. J Obstet Gynaecol Res. 2015;41(8):1201-6.

Bako B, Audu BM, Lawan ZM, Umar JB. Risk factors and microbial isolates of puerperal sepis at the university of Maiduguri teaching hospital, Maiduguri, north-eastern Nigeria. Arch Gynecol Obstet. 2012; 285(4):913-7.

Ngonzi J, Bebell LM, Fajardo Y. Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Preg Childbirth. 2018;18(1):270.

Demisse GA, Sifer SD, Kedir B, Fekene DB, Bulto GA. Determinants of puerperal sepsis among post partum women at public hospitals in west SHOA zone Oromia regional STATE, Ethiopia (institution BASEDCASE control study. BMC Preg Childbirth. 2019;19(1):95.

Acosta CD, Knight M, Lee HC, Kurinczuk JJ, Gould JB, Lyndon A. The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study. PLoS One. 2013;8(7):e671-5.

Taskin T, Sultana M, Islam T, Khan N, Chowdhury S. Socio-demographic factors and puerperal sepsis: Experiences from two tertiary level hospitals in Bangladesh. Int J Community Fam Med. 2016;1(2):12-6.

Naima S. Magnitude and Risk Factors for Puerperal Sepsis at the Pumwani Maternity Hospital. BMC Preg Childbirth. 2017;17(2):23-8.

Kaur T, Mor S, Puri M, Sood R, Nath J. A study of predisposing factors and microbial flora in puerperal sepsis. Int J Reprod Contracept Obstet Gynecol. 2016; 3:3133-6.

Simoes E, Kunz S, Bosing-Schwenkglenks M, Schmahl FW. Association between method of delivery, puerperal complication rate and postpartum hysterectomy. Arch Gynecol Obstet. 2005;272(1):43-7.

Kajeguka DC, Mrema NR, Mawazo A, Malya R, Mgabo MR. Factors and causes of puerperal sepsis in Kilimanjaro, Tanzania: A descriptive study among postnatal women who attended Kilimanjaro Christian Medical Centre. East Afr Health Res J. 2020;4(2):158-63.

Iyoke C, Ezugwu F, Onah H. Prevalence and correlates of maternal morbidity in enugu, south-east Nigeria. Afr J Reprod Health. 2010;14(3):121-9.

El-Mahally AA, Kharboush IF, Amer NH, Hussein M, Abdel Salam T, Youssef AA. Risk factors of puerperal sepsis in Alexandria. J Egypt Public Health Assoc. 2004;79(3-4):311-31.

Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):e323-33.

Bearak J, Popinchalk A, Ganatra B. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990-2019. Lancet Glob Health. 2020;8(9):e1152-61.

Coast E, Lattof SR, Meulen Rodgers Y van der, Moore B, Poss C. The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers. PLoS One. 2021;16(6):e025.

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Published

2023-09-28

How to Cite

Kaur, H., Kaur, S., Mattu, S., & Nandrajog, A. (2023). Burden of puerperal sepsis and its relation with maternal mortality. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 12(10), 3103–3108. https://doi.org/10.18203/2320-1770.ijrcog20232955

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Original Research Articles