Maternal sepsis- an audit in a tertiary care center in South India

Authors

  • Roopa P. Shivananda Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Gurram Bhanuteja Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Shubha Rao Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Nivedita Hegde Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Sangamithra Paladugu Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  • Akhila Vasudeva Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204807

Keywords:

Maternal sepsis, Septic shock, Organ dysfunction, Maternal mortality, Sequential organ failure assessment score

Abstract

Background: Objective of this study was to audit the cases of maternal sepsis and analyze their maternal and fetal outcomes.

Methods: A retrospective analysis of cases of maternal sepsis was undertaken for one year. Cases were taken as infection with fever, tachycardia, tachypnea, low oxygen saturation, high or low white blood counts and clinical or laboratory evidence of organ dysfunction and were analyzed. Demographic profile, gestational age at the time of diagnosis, organisms & their sources of infection was noted. Maternal outcomes of abortion, preterm delivery, need for intensive care unit (ICU) / high dependency unit (HDU) stay, blood and blood products, surgical interventions for the control of infection, culture-positive rate, source of organism, antibiotic usage and maternal mortality were analyzed. Fetal outcomes of early fetal demise, preterm birth, intrauterine death, stillbirth and term birth were studied.  

Results: There were a total of 2327 deliveries, with 2333 live births during the study period. Twenty-two cases were diagnosed with sepsis, of which 17 survived, and five died. The incidence of maternal sepsis was 9.4/1000 live births & maternal deaths were 22.7%. Ninety percent were in the age group of 21-39 years, 68% were referred, 59% were post-delivery. Fifty nine percent of women who survived, and none of the women who died had medical co-morbidities. Respiratory tract followed by genitourinary tract were the most common source of infection, though culture was negative in 54.5% of the cases. The organisms grown were varied, with Escherichia coli (3/10) contributing to 30% of the culture positive cases. Spontaneous abortion and preterm delivery were 18% each, 36% required surgical intervention, 81% required ICU and 64.7% HDU stay. Seventy-seven had live birth.

Conclusions: Maternal sepsis is an evolving preventable health burden. Early recognition requires a high index of clinical suspicion, even in the absence of risk factors. Mortality to morbidity ratio is very high in maternal sepsis. The timing of sepsis determines the fetal outcomes.

Author Biographies

Roopa P. Shivananda, Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Associate Professor

Department of OBG

KMC, Manipal- 576104

Gurram Bhanuteja, Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Junior Resident 

Department of Obstetrics & Gynecology

KMC, Manipal- 576104

Shubha Rao, Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Assistant Professor

Department of Obstetrics & Gynecology

KMC, Manipal-576104

Nivedita Hegde, Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Assistant Professor

Department of Obstetrics & Gynecology

KMC, Manipal-576104

Sangamithra Paladugu, Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Senior resident 

Department of Obstetrics & Gynecology

KMC, Manipal-576104

Akhila Vasudeva, Department of Obstetrics & Gynecology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Professor

Department of Obstetrics & Gynecology

KMC, Manipal-576104

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Published

2020-10-27

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Original Research Articles