Puerperal sepsis in Port Moresby, Papua New Guinea

Because puerperal sepsis is the second most common cause of maternal death in Papua New Guinea some aspects of its aetiology and prevention have been investigated. 91% of 125 women with puerperal fever were found to have post-partum uterine infection. The anaerobes Bacteroides and Peptostreptococcus singly or together, were the commonest causes, while Streptococcus pyogenes was the predominant aerobic species. Antibiotic sensitivity patterns were established, and chloramphenicol was found to be the most active agent against anaerobic and most aerobic strains. Endocervical cultures obtained from 103 ante-partum and 50 afebrile post-partum women demonstrated all the species associated with post-partum genital infection in this study. An analysis of the records of all patients was made to determine the redisposing factors associated with puerperal fever; only operative delivery was found to be significant, especially when it followed prolonged labour. Metronidazole given to 72 women before induction of labour was associated with puerperal fever in 4%, compared with 21% in matched controls.