DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183329

Clinicopathological study of puerperal sepsis including microbiological profile: at a tertiary health care centre

Karthik Chandra Bassetty, Rina Dutta Ahmed, Lahari Saikia

Abstract


Background: Puerperal sepsis in developing countries is a major health problem. Antenatal and labour related risk factors play a huge role in causing puerperal sepsis, many of which are modifiable. The aim of the present study is to study the risk factors, clinical features and outcomes of puerperal sepsis in the mother and determine the causative microorganisms involved.

Methods: A prospective observational study was conducted at the department of Obstetrics and Gynaecology, Assam Medical college and Hospital from 1st July 2016 to 30th June 2017.Peurperal sepsis cases were identified based on the WHO clinical definition. A total of 88 patients were identified. Information regarding occupation, antenatal care, delivery related events and outcome were recorded on a predesigned proforma. Mothers were followed up till discharge from the hospital.

Results: Out of 88 clinically diagnosed patients with puerperal sepsis, common risk factors associated with mortality were young age(p<0.001),primiparity(p 0.005),tea garden workers(p 0.014),few antenatal check-ups and unbooked status (p 0.001) inadequate iron prophylaxis .Among labor related events intrauterine fetal demise (p 0.001), absent membranes on admission (0.001),late presentation (p 0.001) delivery by untrained birth attendant (p <0.001) were significant.24 patients expired due to the disease. Most common isolated in high vaginal swab and blood culture were Klebsiella pneumoniae and CONS respectively.

Conclusions: Proper antenatal care and institutional deliveries are the prime and only preventive measure to reduce the burden of puerperal sepsis in our setup.


Keywords


Microorganisms, Outcomes, Peurperal sepsis, Risk factors, Tertiary institute

Full Text:

PDF

References


Hyakakawa S, Komine-Aizawa S, Naganawa S, Shimuzu K, Nemoto N. The death of Izanami, an ancient Japanese goddess: an early report of a case of puerperal fever. Medical Hypoth. 2006; 67(4):965-8.

Adriaanse AH, Pel M, Bleker OP. Semmelweis: the combat against puerperal fever. Eur J Obstet Gynecol Reproduc Biol. 2000;90(2):153-8.

Ricci JV. The genealogy of gynaecology: history of the development of gynaecology throughout the ages, 2000 BC-1800 AD. Blakiston; 1950.

De Costa CM. The contagiousness of childbed fever: a short history of puerperal sepsis and its treatment. Medi J Aus. 2002; 177(11/12):668-72.

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. The Lancet. 2006;367 (9516):1066-74.

Killian CA, Graffunder EM, Vinciguerra TJ, Venezia RA. Infect Control Hosp Epidemicol. 2001;22(10): 613-7.

Madhudas C, Khurshid F, Sirichand P. Maternal morbidity and mortality associated with puerperal sepsis. JLUMHS. 2011;10(03):121.

World Health Organization. Women and health: today's evidence tomorrow's agenda. World Health Organization; 2009.

Fernandez-Perez ER, Salman S, Pendem S, Farmer JC. Sepsis during pregnancy. Critical Care Medi. 2005;33(10):S286-93

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

Rocca CH, Puri M, Dulal B, Bajracharya L, Harper CC, Blum M, Henderson JT. Unsafe abortion after legalisation in Nepal: a cross‐sectional study of women presenting to hospitals. BJOG: Int J Obstet Gynaecol. 2013;120(9):1075-84.

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

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS. The third international consensus definitions for sepsis and septic shock (sepsis-3). Jama. 2016;315(8):801-10.

Shamshad SS, Rauf B. Puerperal sepsis—still a major threat for parturient. J Ayub Med Coll Abbottabad. 2010;22(3):18-20.

Tamboli SS, Tamboli SB, Shrikhande S. Puerperal sepsis: predominant organisms and their antibiotic sensitivity pattern. Int J Reprod Contracep Obstet Gynecol. 2017;5(3):762-5.

Maharaj D. Puerperal pyrexia: a review. Part I. Obstet Gynecol Survey. 2007;62(6):393-9.

Kaur T, Mor S, Puri M, Sood R, Nath J. A study of predisposing factors and microbial flora in puerperal sepsis. Int J Reprod Contracep Obstet Gynecol. 2017;5(9):3133-6.

Dare FO, Bako AU, Ezechi OC. Puerperal sepsis: a preventable post-partum complication. Trop Doctor. 1998;28(2):92-5.

Pradhan B, Duwal SS, Singh A, Bhandary S, RC L, Shrestha R. Puerperal Sepsis and its Cause in Patan Hospital. Nepal J Obstet Gynaecol. 2015;10(1):33-5.

Venugopal MS, Bhaskaran CS. Puerperal and postabortal sepsis (a bacteriological study). J Obstet Gynaecol India. 1968;18 (1):70.

Ahmed MI, Alsammani MA. Puerperal sepsis in a rural hospital in Sudan. Materia socio-Medica. 2013; 25(1):19.

Ahmed S, Kawaguchiya M, Ghosh S, Paul SK, Urushibara N, Mahmud C, et al. Drug resistance and molecular epidemiology of aerobic bacteria isolated from puerperal infections in Bangladesh. Microbial Drug Resistance. 2015;21(3):297-306.

Shagufta Qadri. Microbial Profile in Females with Puerperal Sepsis: A Major Threat to Women s Health: Study at a Tertiary Health Care Centre. Int J Curr Microbiol App Sci. 2015;1:248-55.