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Seboka K, Gurara AM, Bekele NT, Belachwe YA, Getahun MS, Negussie YM. Determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia: an unmatched case-control study. Contracept Reprod Med 2024; 9:18. [PMID: 38654384 DOI: 10.1186/s40834-024-00283-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Puerperal sepsis, is a significant factor in maternal morbidity and mortality, especially in regions with lower income levels where maternal mortality rates are highest. However, it can be largely avoided if detected in time. Recognizing and dealing with the root causes early is essential in addressing this problem. Therefore, this study aimed to identify the determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia. METHODS An institutional-based unmatched case-control study was conducted among 266 postpartum women (88 cases and 178 controls) from October 1, 2023 to November 30, 2023. For each case, two controls were chosen using a systematic random sampling approach. Data were collected using an interviewer-administered, structured questionnaire and medical record review. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 27. Binary logistic regression analysis was used to model the association between puerperal sepsis and independent variables. variables that had a crude association in the bivariable analysis (p < 0.25) were entered and analyzed by a multivariable binary logistic regression model to identify statistically significant factors. In the final model, Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. Statistical significance was declared at p < 0.05. RESULT Rural residence (AOR = 6.9; 95% CI:2.77-17.10), having no formal education (AOR = 3.8; 95% CI: 2.55, 10.76), cesarean section delivery (AOR: 5.1; 95% CI: 1.30, 11.00) and complication during pregnancy (AOR: 4.6, 95% CI: 1.96, 11.10) were independent determinants of puerperal sepsis. CONCLUSION Place of residence, maternal education level, mode of delivery, and complication during pregnancy were determinants of puerperal sepsis. It is crucial to implement education and awareness initiatives aimed at mothers, ensure universal access to healthcare services, advocate for evidence-based delivery protocols, and conduct comprehensive antenatal screenings.
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Affiliation(s)
- Keraj Seboka
- Department of Nursing, Adama General Hospital and Medical College, Adama, Ethiopia
| | | | | | - Yohanes Abera Belachwe
- Department of Public Health, Adama General Hospital and Medical College, Adama, Ethiopia
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Abera BT, Teka H, Gebre D, Gebremariam T, Berhe E, Gidey H, Amare B, Kidanemariam R, Gebru MA, Tesfay F, Zelelow YB, Yemane A, Gebru F, Tekle A, Tadesse H, Yahya M, Tadesse Y, Abraha HE, Alemayehu M, Ebrahim MM. Maternal sepsis and factors associated with poor maternal outcomes in a tertiary hospital in Tigray, Ethiopia: a retrospective chart review. BMC Infect Dis 2024; 24:170. [PMID: 38326776 PMCID: PMC10848478 DOI: 10.1186/s12879-024-09075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. METHODS A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. RESULTS Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. CONCLUSIONS This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options.
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Affiliation(s)
- Bisrat Tesfay Abera
- Department of Internal Medicine, School of Medicine, Mekelle University, Box: 1871, Mekelle, Tigray, Ethiopia.
| | - Hale Teka
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Daniel Gebre
- Department of Midwifery, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia
| | - Tsega Gebremariam
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ephrem Berhe
- Department of Internal Medicine, School of Medicine, Mekelle University, Box: 1871, Mekelle, Tigray, Ethiopia
| | - Hagos Gidey
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Birhane Amare
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Rahel Kidanemariam
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Marta Abrha Gebru
- Department of Internal Medicine, School of Medicine, Mekelle University, Box: 1871, Mekelle, Tigray, Ethiopia
| | - Fireweyni Tesfay
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Yibrah Berhe Zelelow
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Awol Yemane
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Fanus Gebru
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ashenafi Tekle
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Habtom Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Mohammedtahir Yahya
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Ytbarek Tadesse
- Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hiluf Ebuy Abraha
- Department of Biostatistics, School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
- University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Mussie Alemayehu
- Department of Reproductive Health, School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
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Sahle SG, Weldemariam S, Mehari MA, Abraha TA. Determinants of puerperal sepsis among post-partum mothers in Mekelle city public hospitals, Tigray, Ethiopia, 2021: a case control study. BMC Womens Health 2023; 23:502. [PMID: 37735640 PMCID: PMC10512567 DOI: 10.1186/s12905-023-02643-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Puerperal sepsis is among the leading causes of preventable maternal death not only in developing countries but also in developed countries which is usually reported as the third or fourth common direct cause of maternal death. Although the prevalence of puerperal sepsis is low, it is the significant cause of maternal mortality, morbidities and other long-term complications like secondary infertility. The aim of this study was to assess the determinants of puerperal sepsis among post-partum mothers at Mekelle city public hospitals. METHOD Institution based unmatched case control study was conducted among 444 total sample size (111 cases and 333 controls) in Mekelle city public hospitals from March 21, 2021 to April 20, 2021. Consecutive sampling for the cases and systematic sampling for the controls was used. Pretested structured questionnaire was used to collect data and the data was entered into Epi data version 4.1 then cleaned, coded and edited and exported to SPSS version 23 statistical software for analysis. Logistic regression was done and variables with a P-value of < 0.25 on Binary logistic regression were taken to multiple logistic regression analysis. At 95% confidence interval, a P-value of < 0.05 was used as cut-off point to declare the association with the dependent variable. RESULTS Multiple logistic regression analysis revealed that rural residence (AOR: 3, 95% CI: 1.50-5.90), no ANC follow up (AOR: 2.7, 95% CI: 1.08-6.71), duration of rupture of membrane > 24 h (AOR: 4.1, 95% CI: 1.60-10.58), duration of labor > 24 h (AOR: 4.3, 95% CI: 1.86-9.92), number of vaginal examination > = 5 (AOR: 2.8, 95% CI: 1.26-6.26), cesarean section mode of delivery (AOR: 2.8, 95% CI: 1.48-5.20) and no PNC follow up (AOR: 3.9, 95% CI: 1.60-9.36) were the determinant factors of puerperal sepsis in this study. CONCLUSION The determinants of puerperal sepsis in this study were rural residence, not having antenatal care, prolonged duration of rupture of membrane, prolonged duration of labor, frequent number of vaginal examination, cesarean section and not having postnatal care. It is recommended that strengthening provision of health education on danger signs of pregnancy, parthograph utilization and avoiding of frequent vaginal examinations.
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Affiliation(s)
| | - Solomon Weldemariam
- Midwifery Department, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Mihret-Ab Mehari
- Midwifery Department, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Tomas Amare Abraha
- Midwifery Department, College of Health Science, Mekelle University, Mekelle, Ethiopia.
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Marandu LE, Masika GM. Healthcare workers' level of adherence to infection prevention and control and its impact on puerperal and neonatal sepsis among delivering women and neonates in Central Tanzania: a protocol for a prospective cohort study. BMJ Open 2023; 13:e066701. [PMID: 36918240 PMCID: PMC10016239 DOI: 10.1136/bmjopen-2022-066701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Delivering women and neonates are at a great risk of acquiring infections due to a lack of adherence to infection prevention and control (IPC), a low level of immunity and extended exposure to care procedures that can lead to infections. This prospective cohort study aims to assess the level of adherence to IPC among healthcare workers and its impact on puerperal and neonatal sepsis in the Dodoma region. METHODS AND ANALYSIS The level of adherence to IPC is examined cross-sectionally among healthcare workers (HCWs) in contact with delivering women and their neonates. A prospective cohort approach is used to assess the level of exposure of 294 delivering women and their neonates to poor hygienic practices of HCWs through an observation checklist. Outcomes, including the incidence of puerperal and neonatal sepsis, are evaluated clinically 2 days later before discharge. Laboratory culture and sensitivity confirmatory tests of blood samples are done on positive cases. Data analysis for level of adherence to IPC practices, incidence of puerperal and neonatal sepsis, and relative risk among the exposed women and neonates will be performed. ETHICS AND DISSEMINATION The University of Dodoma Research Ethics Committee approved this study (ref no. MA.84/261/'A'/25). Findings of this study will be published in international peer-reviewed journals and disseminated at international conferences to the participating hospitals, the University of Dodoma and the Tanzanian Ministry of Health for informing practice and policy.
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Affiliation(s)
- Laura Edward Marandu
- Department of Clinical Nursing, The University of Dodoma, Dodoma, Tanzania, United Republic of
- Department of Health Quality Assurance, Ministry of Health, Dodoma, Tanzania, United Republic of
| | - Golden Mwakibo Masika
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania, United Republic of
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Bishaw KA, Sharew Y, Beka E, Aynalem BY, Zeleke LB, Desta M, Kassie B, Amha H, Eshete T, Tamir W, Bantigen K, Mulugeta H, Ferede AA, Bitewa YB. Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study. Front Glob Womens Health 2023; 4:966942. [PMID: 36760237 PMCID: PMC9902590 DOI: 10.3389/fgwh.2023.966942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023] Open
Abstract
Background Puerperal sepsis is one of the leading causes of maternal mortality, particularly in low and middle-income countries where most maternal deaths occur. Women with puerperal sepsis are prone to long-term disabilities, such as chronic pelvic pain, blocked fallopian tubes, and secondary infertility. Besides this, puerperal sepsis has received less attention. For this reason, this study aimed to determine the incidence of puerperal sepsis and its predictors among postpartum women at Debre Markos Comprehensive Specialized Hospital. Methods A prospective cohort study was conducted among 330 postpartum women from September 2020 to 2021. A pre-tested interviewer-administered questionnaire with a data extraction checklist was used to collect the data. Data were entered into Epi data 4.2 and analyzed using STATA 14.0. The incidence rate of puerperal sepsis was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probability of developing puerperal sepsis. The cox-proportional hazards regression model was fitted to identify predictors of puerperal sepsis. Results The study participants were followed for a total of 1685.3 person-week observations. The incidence rate of puerperal sepsis was 14.24 per 1,000 person-weeks. However, the overall incidence of puerperal sepsis was 7.27%. Not attending formal education [AHR: 3.55, 95% CI: (1.09-11.58)], a cesarean delivery [AHR: 4.50; 95% CI: (1.79-11.30)], premature rupture of the membranes [AHR: 3.25; 95% CI: (1.08-9.79)], complicated pregnancy [AHR: 4.80; 95% CI: (1.85-12.43)], being referred [AHR: 2.90; 95% CI: (1.10-7.65)], and not having birth preparedness and complication readiness plan [AHR: 2.95; 95% CI: (1.08-10.50)] were statistically significant predictors of puerperal sepsis. Conclusion The incidence of puerperal sepsis was 7.27%. Not attending formal education, cesarean delivery, premature rupture of membranes, complicated pregnancy, referral status, and absence of birth preparedness and complication readiness plan were predictors associated with the incidence of puerperal sepsis.
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Affiliation(s)
- Keralem Anteneh Bishaw
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia,Correspondence: Keralem Anteneh Bishaw
| | - Yewbmirt Sharew
- Department of Midwifery, Injibara University, Injibara, Ethiopia
| | - Endihnew Beka
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | | | | | - Melaku Desta
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Kassie
- Department of Midwifery, Debre Markos University, Debre Markos, Ethiopia
| | - Haile Amha
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Eshete
- Department Health Informatics, Debre Markos University, Debre Markos, Ethiopia
| | - Workineh Tamir
- Department of Laboratory, Injibara University, Injibara, Ethiopia
| | - Kerebih Bantigen
- School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henok Mulugeta
- Department of Midwifery, Injibara University, Injibara, Ethiopia
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Kalbarczyk A, Mir F, Ariff S, Ali Nathwani A, Kazi M, Kaur G, Yousuf F, Hirani F, Sultana S, Bartlett LA, Lefevre AE, Bhutta S, Soofi S, Zaidi AKM, Winch PJ. Exploring terminology for puerperal sepsis and its symptoms in urban Karachi, Pakistan to improve communication, care-seeking, and illness recognition. Glob Public Health 2022; 17:3825-3838. [PMID: 36038965 DOI: 10.1080/17441692.2022.2115527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. Awareness of local terminology for its signs and symptoms may improve communication about this illness, what actions to take when symptoms appear, timely care seeking, and clinical outcomes. This formative research aimed to improve recognition and management of postpartum sepsis in Pakistan by eliciting local terms used for postpartum illnesses and symptoms. We conducted 32 in-depth interviews with recently delivered women, their relatives, traditional birth attendants, and health care providers to explore postpartum experiences. Terms for symptoms and illness are used interchangeably (i.e. bukhar, the Urdu word for fever), many variations exist for the same term, and gradations of severity for each term as not associated with different types of illnesses. The lack of a designated term for postpartum sepsis in Urdu delays care-seeking and proper diagnosis, particularly at the community level. Ideally, a common lexicon for symptoms and postpartum sepsis would be developed but this may not be feasible or appropriate given the nature of the Urdu language and local understandings of postpartum illness. These insights can inform how we approach educational campaigns, the development of clinical algorithms that focus on symptoms, and counselling protocols.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fatima Mir
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Shabina Ariff
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Apsara Ali Nathwani
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Momin Kazi
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Gurpreet Kaur
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Farheen Yousuf
- Obstetrics and Gynaecology, The Aga Khan University Karachi, Karachi, Pakistan
| | - Farzeen Hirani
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Shazia Sultana
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Linda A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amnesty E Lefevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shereen Bhutta
- Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center Karachi, Karachi, Pakistan
| | - Sajid Soofi
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Olutoye AS, Agboola AD, Bello OO. PUERPERAL SEPSIS AT UNIVERSITY COLLEGE HOSPITAL, IBADAN: A 10-YEAR REVIEW. Ann Ib Postgrad Med 2022; 20:32-39. [PMID: 37006644 PMCID: PMC10061674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Background Puerperal sepsis is one of the leading causes of pregnancy-related maternal morbidity and mortality in developing countries. This study explored the complications, treatment modalities, and management outcomes of puerperal sepsis. Methods A 10-year retrospective review of women managed for puerperal sepsis at University College Hospital, Ibadan, Nigeria between January 2009 and December 2018. Information on their socio-demographic and obstetrics characteristics, presenting complaints, treatment modalities, complications, and outcomes were obtained from the medical records. Data was analyzed with SPSS version 20. Descriptive statistics was done and results were presented in tables and chart. Results The prevalence of puerperal sepsis during the period reviewed was 0.83%. The mean age of the women was 29.0±6.7 years. The primiparous women 53(33.5%) were mostly affected. Klebsiella spp 25(15.8%) was the most common organism isolated and most sensitive to the third generation of Cephalosporin and Quinolones. Anaemia 90(56.8%) was the most common complication and all the women had intravenous antibiotics while about half (46.5%) of those with abdominopelvic collections were managed surgically via laparotomy. The case fatality rate was 16.5%. Conclusion Despite the low prevalence of puerperal sepsis within the period reviewed, a high case fatality was recorded. Cephalosporin and Quinolones should be considered in managing puerperal sepsis in our facility but more importantly prevention of maternal sepsis is essential.
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Affiliation(s)
- A S Olutoye
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - A D Agboola
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | - O O Bello
- Dpartment of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Dpartment of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Yousuf F, Malik A, Saba A, Sheikh S. Risk factors and Compliance of surviving sepsis campaign: A retrospective cohort study at tertiary care hospital. Pak J Med Sci 2022; 38:90-94. [PMID: 35035406 PMCID: PMC8713188 DOI: 10.12669/pjms.38.1.3992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 07/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sepsis is one of the leading causes of direct maternal mortality in Pakistan. It is recommended that the first three hours after the presentation are crucial. During this time implementation of surviving sepsis campaign resuscitation bundles reduces maternal mortality. Our objective was to assess the factors contributing to puerperal sepsis and the compliance of "surviving sepsis campaign resuscitation bundles in puerperal sepsis" for the management of puerperal sepsis. METHODS This was a retrospective record review for five years from January 2011-December 2015. All women who fulfilled the inclusion criteria of puerperal sepsis were included and data from their files were collected and entered in SPSS version 19.0. Mean and standard deviations were calculated for continuous variables while for categorical variable proportion and percentages were used. RESULTS This retrospective record review in five years showed the 396 patients had P-sepsis, among them 44 patients had severe sepsis with organ dysfunction. The culture was positive in 26(59%) with trend of E-coli in 9(20%) Among them 12(27%) had serum lactate more than ≥4mmol/L. Central venous pressure monitoring with fluid resuscitation was done as per protocol of survival bundle given to all 12(100%), Vasopressin was needed in half of these patients 6(50%). Amid 44 patients of severe sepsis 29(66%) were admitted to special care, while 15(34%) required intensive care admissions. Our 7(16%) patients failed to survive. All of them had multi-organ failure. CONCLUSION There was moderate adherence of modified surviving sepsis campaign resuscitation bundles. Further improvement in compliance is warranted.
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Affiliation(s)
- Farheen Yousuf
- Dr. Farheen Yousuf, FRCOG, MCPS(HPE), FCPS. Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Ayesha Malik
- Dr. Ayesha Malik, MRCOG, FCPS. Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Ayesha Saba
- Dr. Ayesha Saba, FCPS. Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Sana Sheikh
- Dr. Sana Sheikh, Masters in Epidemiology and Biostatics Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
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Melkie A, Dagnew E. Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis. Arch Public Health 2021; 79:216. [PMID: 34844656 PMCID: PMC8628469 DOI: 10.1186/s13690-021-00732-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Puerperal sepsis is a genital tract infection that can occur from amniotic fluid rupture to six weeks after birth. Maternal complication associated with puerperal sepsis includes prolonged hospital stay, septicemia, disseminated intravascular coagulation, pelvic inflammatory disease, infertility, and death. Even though, puerperal sepsis is the fourth leading cause of maternal morbidity and mortality in Ethiopia the overall prevalence of puerperal sepsis and its associated factors are not studied at the national stage. As a result, this systematic review and meta-analysis bring out the pooled prevalence of puerperal sepsis and its associated factors in Ethiopia. METHODS A variety of data sources such as Pub Med, Web of Science, Science Direct, Embase, Google Scholar, HINARI, and Ethiopian universities online repositories were searched to identify the primary studies which were used for this systematic review and meta-analysis. The article search was conducted from February10/2021-March 10/2021. The quality of the selected primary studies was assessed using the Newcastle - Ottawa quality assessment Scale (NOS). Data extraction was done with Microsoft Excel and then exported to STATA 11 version statistical software for analysis. The Cochran (Q-test) and I2 test statistics were used to assess the heterogeneity of the studies. Publication bias was evaluated by the eggers regression test. Subgroup analysis was performed with region and sample size category. RESULT In this review, a total of 2222 respondents were involved from seven studies. The pooled prevalence of puerperal sepsis was 14.811% (95%CI; 8.46: 21.16; I2 = 94.2, P ≤ 0.001). Cesarean section delivery (CSD) (OR = 3.26, 95%CI: 1.90, 5.61), membrane rupture≥24 h (OR = 4.04, 95%CI: 2.54, 6.42), being multiparous mother (OR = 3.99, 95%CI: 1.82, 8.78), vaginal examination≥5 times (OR = 3.15, 95%CI: 1.17, 8.52), and anemia (OR = 5.68, 95%CI: 4.38, 7.36) were factors significantly associated with puerperal sepsis. CONCLUSION The prevalence of puerperal sepsis was high in Ethiopia. CSD, membrane rupture≥24 h, being multiparous mother, vaginal examination≥5, and anemia were factors associated with puerperal sepsis. Appropriate standard infection prevention techniques during CSD shall be practiced to reduce the maternal burden of puerperal sepsis. The unnecessary vaginal examination should be discouraged during the intrapartum period. Besides this, routine Iron sulfate supplementation and counsel on iron reach foods during ante partum and postpartum shall be considered for all mothers.
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Affiliation(s)
- Abenezer Melkie
- Department of midwifery, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
| | - Enyew Dagnew
- Department of midwifery, Debre Tabor University, College of Health Sciences, Debre Tabor, Ethiopia
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Bakhtawar S, Sheikh S, Qureshi R, Hoodbhoy Z, Payne B, Azam I, von Dadelszen P, Magee L. Risk factors for postpartum sepsis: a nested case-control study. BMC Pregnancy Childbirth 2020; 20:297. [PMID: 32410594 PMCID: PMC7227107 DOI: 10.1186/s12884-020-02991-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Majority (99%) of maternal deaths occur in low and middle-income countries. The three most important causes of maternal deaths in these regions are postpartum hemorrhage, pre-eclampsia and puerperal sepsis. There are several diagnostic criteria used to identify sepsis and one of the commonly used criteria is systematic inflammatory response syndrome (SIRS). However, these criteria require laboratory investigations that may not be feasible in resource-constrained settings. Therefore, this study aimed to develop a model based on risk factors and clinical signs and symptoms that can identify sepsis early among postpartum women. Methods A case-control study was nested in an ongoing cohort of 4000 postpartum women who delivered or were admitted to the study hospital. According to standard criteria of SIRS, 100 women with sepsis (cases) and 498 women without sepsis (controls) were recruited from January to July 2017. Information related to the socio-demographic status, antenatal care and use of tobacco were obtained via interview while pregnancy and delivery related information, comorbid and clinical sign and symptoms were retrieved from the ongoing cohort. Multivariable logistic regression was performed and discriminative performance of the model was assessed using area under the curve (AUC) of the receiver operating characteristic (ROC). Results Multivariable analysis revealed that 1–4 antenatal visits (95% CI 0.01–0.62). , 3 or more vaginal examinations (95% CI 1.21–3.65), home delivery (95% CI 1.72–50.02), preterm delivery, diabetes in pregnancy (95% CI 1.93–20.23), lower abdominal pain (95% CI 1.15–3.42)) vaginal discharge (95% CI 2.97–20.21), SpO2 < 93% (95% CI 4.80–37.10) and blood glucose were significantly associated with sepsis. AUC was 0.84 (95% C.I 0.80–0.89) which indicated that risk factors and clinical sign and symptoms-based model has adequate ability to discriminate women with and without sepsis. Conclusion This study developed a non-invasive tool that can identify postpartum women with sepsis as accurately as SIRS criteria with good discriminative ability. Once validated, this tool has the potential to be scaled up for community use by frontline health care workers.
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Affiliation(s)
- Samina Bakhtawar
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sana Sheikh
- Department of obstetrics and gynecology, Aga Khan University, Karachi, Pakistan.
| | - Rahat Qureshi
- Department of obstetrics and gynecology, Aga Khan University, Karachi, Pakistan
| | - Zahra Hoodbhoy
- Department of obstetrics and gynecology, Aga Khan University, Karachi, Pakistan
| | - Beth Payne
- University of British Columbia, Vancouver, Canada
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Laura Magee
- Global Women's Health, King's College, London, UK
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Admas A, Gelaw B, BelayTessema, Worku A, Melese A. Proportion of bacterial isolates, their antimicrobial susceptibility profile and factors associated with puerperal sepsis among post-partum/aborted women at a referral Hospital in Bahir Dar, Northwest Ethiopia. Antimicrob Resist Infect Control 2020; 9:14. [PMID: 31956403 PMCID: PMC6958633 DOI: 10.1186/s13756-019-0676-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/29/2019] [Indexed: 01/10/2023] Open
Abstract
Background Puerperal sepsis is any bacterial infection of the genital tract that occurs after childbirth. It is among the leading causes of maternal morbidity and mortality especially in low-income countries including Ethiopia. The aim of this study was to determine the proportion of bacterial isolates, their antimicrobial susceptibility profile and factors associated with puerperal sepsis among post-partum/aborted women at a Referral Hospital in Bahir Dar, Northwest Ethiopia. Methods A cross sectional study was conducted from January to May 2017 among 166 post-partum/aborted women admitted to Felege Hiwot Referral Hospital for medical services and suspected for puerperal sepsis.. Socio-demographic data and associated factors were collected using structured questionnaire. Bacteria were isolated and identified from blood samples on Trypton soya broth, blood, Chocolate and MacConkey agars following standard bacteriological procedures. The VITEK 2 identification and susceptibility testing system was used to determine the antimicrobial susceptibility profiles of bacterial isolates. Data were entered and analyzed using SPSS version 20. Factors associated with puerperal sepsis were considered statistically significant at P-value < 0.05. Results The overall proportion of bacterial isolates among post-partum/aborted women was 33.7% (56/166); of which 55.4% was caused by Gram-negative and 44.6% was by Gram-positive bacteria. The most frequently isolated bacteria were Escherichia coli (32.1%) from Gram-negatives and Staphylococcus aureus (33.9%) from Gram-positives. The proportion of other isolates was (7.2%) for Coagulase Negative Staphylococci (CoNS), (12.5%) for Klebsiella pneumoniae, (10.7%) for Acinetobacter baumanni and (3.6%) for Raoultella ornithinolytica. All isolates of Gram-positive and Gram-negative bacteria were resistant to tetracycline (100%). The gram negatives show resistance to Cefazolin (72.7%), Tetracycline (93.9%) and Ampicillin (100%). The overall prevalence of multidrug resistance (MDR) was 84%. Women having multiparous parity were more likely to develop puerperal sepsis than primiparous parity (AOR 4.045; 95% CI: 1.479-11.061; P < 0.05). Other socio-demographic and clinical factors had no significant association with puerperal sepsis. Conclusion About one third of post-partum/aborted women suspected for puerperal sepsis were infected with one or more bacterial isolates. Significant proportion of bacterial isolates showed mono and multi-drug resistance for the commonly prescribed antibiotics. Women with multiparous parity were more likely to develop puerperal sepsis than primiparous parity.
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Affiliation(s)
- Alemale Admas
- 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Baye Gelaw
- 2Department of Medical Microbiology, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - BelayTessema
- 2Department of Medical Microbiology, School of Biomedical and Laboratory Science, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amsalu Worku
- 3Department of Gynecology and Obstetrics, School of Medicine, Bahir Dar University, Bahir Dar, Ethiopia
| | - Addisu Melese
- 1Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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12
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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; 4:158-163. [PMID: 34308233 PMCID: PMC8279318 DOI: 10.24248/eahrj.v4i2.639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 11/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Puerperal sepsis is the major cause of maternal morbidity and mortality worldwide. About 94% of maternal mortality occur in low and middle-income countries including Tanzania. Objective: To estimate the prevalence, document factors and causes of puerperal sepsis among postnatal women who attended postnatal care in Kilimanjaro Christian Medical Centre Hospital in the year 2015. Methodology: A descriptive cross-sectional study was carried out at Kilimanjaro Christian Medical Centre, Tanzania. A total of 183 medical records of attendance in 2015 were used for the study. Information about the isolated organism in culture was retrieved from the Laboratory Information System. Results: The prevalence of puerperal sepsis was 11.5% (21/183). The most common factors and causes of puerperal sepsis included caesarean section 66.7% (14/21), postpartum haemorrhage 57.1% (12/21), moderate to severe anaemia 61.9% (13/21), prolonged labour 76.2% (16/21) and bacterial infection 90.5% (19/21). The difference was significant at p<.05. The most bacteria species isolated among women with puerperal sepsis was Staphylococcus spp 50.0% (7/14), Escherichia 28.6% (4/14) and Streptococcus spp 21.4% (3/14). Conclusion: Puerperal sepsis is prevalent (11.5%) at Kilimanjaro Christian Medical Centre. Staphylococcus spp was found to be a predominant isolate which causes puerperal sepsis followed by E. coli and Streptococcus spp.
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Affiliation(s)
- Debora C Kajeguka
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Neema Reuben Mrema
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Akili Mawazo
- Faculty of Medicine, Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rosemary Malya
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maseke R Mgabo
- Faculty of Medicine, Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Department of Population Studies, Institute of Rural Development Planning
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13
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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 Pregnancy Childbirth 2019; 19:95. [PMID: 30885159 PMCID: PMC6423770 DOI: 10.1186/s12884-019-2230-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Puerperal sepsis is an infection of the genital tract, which occurs from rupture of amniotic sacs and within 42ndday after delivery. It happens mainly after discharge in the 1st 24 h of parturition. It is the third leading cause of direct maternal mortality in developing nations. It is also among preventable conditions. Even though multiple interventions were done to overcome these health problems, maternal mortality and morbidities were still significant. Mainly, in Ethiopia lack of clearly identified causes of maternal mortality and morbidity makes the problem unsolved. METHODS Case-control study was conducted at public Hospitals in west shoa zone Oromia regional state, Ethiopia from February 01 to April 30/2018.women with puerperal sepsis (n = 67) were selected by convenience method. Controls (n = 213) were selected by systematic random sampling. Controls to cases ratio was 3:1 and structured questionnaire was used to interviewafter verbal consent was obtained. Data was entered in to epi -info 7.2 then exported to SPSS version 20.0 for analysis. A logistic regression model was used for data analysis. Those variables which have p-value < 0.05 were accepted that they are independent determinants of puerperal sepsis. RESULT Rural residence (AOR [95%CI] = 2.5(1.029-6.054),Mothers with no formal education (AOR [95%CI] = 6.74([1.210-37.541]), up to primary level of education(AOR [95%CI] = 6.72(1.323-34.086), total monthly income of the mother or family<=500 ETB and 501-1500 ETB(AOR [95%CI] = 5.94(1.471-23.93) and (AOR [95%CI] =6.57 (1.338-32.265) respectively, Mothers having 1-2 times antenatal care(ANC)visit (AOR [95%CI] = 6.57([1.338-32.265]), Duration of Labor12-24 h (AOR [95%CI] = 3.12 (1.805-12.115),> = 25 h (AOR [95%CI] = 4.71([1.257-17.687]),vaginal examinations > = 5times (AOR [95%CI] = 4.00([1.330-12.029]), Delivery by C/S (AOR [95%CI] = 3.85 ([1.425-10.413]), Rupture of membrane > 24 h (AOR [95%CI] = 3.73([1.365-10.208]) and those Referred from other health institutions (AOR [95%CI] = 2.53([1.087-5.884],were independent determinants of puerperal sepsis in this study. CONCLUSION Majority of determinants of puerperal sepsis were related with pregnancy and childbirth. Therefore, to tackle a problem of puerperal sepsis all concerning bodies should take measures during prenatal, natal and postnatal period.
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Affiliation(s)
- Getu Alemu Demisse
- Department of Public health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Samuel Dessau Sifer
- Departmentof Nursing, Arbaminch college of health science, Arbainch, Ethiopia
| | | | - Daniel Belema Fekene
- Department of midwifery, Ambo University College of medicine and health science, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of midwifery, Ambo University College of medicine and health science, Ambo, Ethiopia
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14
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Ngonzi J, Bebell LM, Fajardo Y, Boatin AA, Siedner MJ, Bassett IV, Jacquemyn Y, Van Geertruyden JP, Kabakyenga J, Wylie BJ, Bangsberg DR, Riley LE. Incidence of postpartum infection, outcomes and associated risk factors at Mbarara regional referral hospital in Uganda. BMC Pregnancy Childbirth 2018; 18:270. [PMID: 29954356 PMCID: PMC6022296 DOI: 10.1186/s12884-018-1891-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 06/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background There is a paucity of recent prospective data on the incidence of postpartum infections and associated risk factors in sub-Saharan Africa. Retrospective studies estimate that puerperal sepsis causes approximately 10% of maternal deaths in Africa. Methods We enrolled 4231 women presenting to a Ugandan regional referral hospital for delivery or postpartum care into a prospective cohort and measured vital signs postpartum. Women developing fever (> 38.0 °C) or hypothermia (< 36.0 °C) underwent symptom questionnaire, structured physical exam, malaria testing, blood, and urine cultures. Demographic, treatment, and post-discharge outcomes data were collected from febrile/hypothermic women and a random sample of 1708 normothermic women. The primary outcome was in-hospital postpartum infection. Multivariable logistic regression was used to determine factors independently associated with postpartum fever/hypothermia and with confirmed infection. Results Overall, 4176/4231 (99%) had ≥1 temperature measured and 205/4231 (5%) were febrile or hypothermic. An additional 1708 normothermic women were randomly selected for additional data collection, for a total sample size of 1913 participants, 1730 (90%) of whom had complete data. The mean age was 25 years, 214 (12%) were HIV-infected, 874 (51%) delivered by cesarean and 662 (38%) were primigravidae. Among febrile/hypothermic participants, 174/205 (85%) underwent full clinical and microbiological evaluation for infection, and an additional 24 (12%) had a partial evaluation. Overall, 84/4231 (2%) of participants met criteria for one or more in-hospital postpartum infections. Endometritis was the most common, identified in 76/193 (39%) of women evaluated clinically. Twenty-five of 175 (14%) participants with urinalysis and urine culture results met criteria for urinary tract infection. Bloodstream infection was diagnosed in 5/185 (3%) participants with blood culture results. Another 5/186 (3%) tested positive for malaria. Cesarean delivery was independently associated with incident, in-hospital postpartum infection (aOR 3.9, 95% CI 1.5–10.3, P = 0.006), while antenatal clinic attendance was associated with reduced odds (aOR 0.4, 95% CI 0.2–0.9, P = 0.02). There was no difference in in-hospital maternal deaths between the febrile/hypothermic (1, 0.5%) and normothermic groups (0, P = 0.11). Conclusions Among rural Ugandan women, postpartum infection incidence was low overall, and cesarean delivery was independently associated with postpartum infection while antenatal clinic attendance was protective.
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Affiliation(s)
- Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Lisa M Bebell
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Adeline A Boatin
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark J Siedner
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Hospital Center for Global Health, Boston, MA, USA
| | - Ingrid V Bassett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Yves Jacquemyn
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | - Jerome Kabakyenga
- Institute of Maternal Newborn and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Blair J Wylie
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - David R Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Laura E Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
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15
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Vanukuru J, Bagga R, Muthyala T, Gautam V, Sethi S, Jain V, Sikka P. A clinical and microbiological study of puerperal sepsis in a tertiary care hospital in India. J Matern Fetal Neonatal Med 2018; 32:1931-1937. [DOI: 10.1080/14767058.2017.1421933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jayasree Vanukuru
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rashmi Bagga
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tanuja Muthyala
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Gautam
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Sethi
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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16
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Marwah S, Topden SR, Sharma M, Mohindra R, Mittal P. Severe Puerperal Sepsis-A Simmering Menace. J Clin Diagn Res 2017; 11:QC04-QC08. [PMID: 28658852 PMCID: PMC5483754 DOI: 10.7860/jcdr/2017/23710.9815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/18/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Even decades after the development of effective low-cost antibiotics, sepsis persists as the foremost cause of preventable maternal death worldwide. In developing countries like India, where the paramount impediment to intervention is poverty, maternal mortality due to sepsis is a continuing representation of maternal health inequality. AIM To determine the incidence, risk factors and mortality in women presenting with puerperal sepsis in a tertiary care health facility in India. MATERIALS AND METHODS This retrospective study was carried out in VMMC and Safdarjung Hospital, New Delhi, India, from January 2016 to June 2016 in Department of Obstetrics and Gynaecology. Case records of all eligible patients of puerperal sepsis were reviewed and data were extracted regarding demographic profile, clinical profile on admission, course in hospital, management, complications and cause of mortality (in case of death). Inclusion criteria were any patient presenting either immediately after delivery or miscarriage or within 42 days of these events with fever and any of the following: pain abdomen, malodorous lochia, abdominal distention, uterine tenderness, pelvic abscess, peritonitis, mechanical or foreign body injury, any system/organ failure or shock. Exclusion criteria consisted of patients presenting with fever during pregnancy or more than 42 days after delivery or miscarriage, or patients presenting with fever due to medical conditions, wound infection, mastitis, UTI or thrombophlebitis. Data were entered in predesigned proformas and analysed. A p-value of less than 0.05 was considered significant. RESULTS During the study period, a total of 33 cases met the inclusion criteria. Of these, 90% were referred cases. Anaemia, prolonged labour, delivery by an untrained person and unsafe abortion were the main identifiable risk factors. Surgical management was required in 75% cases, while 70% women succumbed to their illness, mostly due to multiorgan failure. CONCLUSION Maternal mortality due to maternal sepsis is very high; Lack of safe and hygienic practices for conducting delivery and abortion are important contributory factors.
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Affiliation(s)
- Sheeba Marwah
- Research Officer, Department of Obstetrics and Gynecology, Vmmc and Safdarjung Hospital, New Delhi, India
| | - Sonam R Topden
- Consultant, Department of Obstetrics and Gynecology, Vmmc and Safdarjung Hospital, New Delhi, India
| | - Manjula Sharma
- Professor and Consultant, Department of Obstetrics and Gynecology, Vmmc and Safdarjung Hospital, New Delhi, India
| | - Ritin Mohindra
- Assistant Professor, Department of Emergency Medicine, AIIMS, New Delhi, India
| | - Pratima Mittal
- Professor and Consultant, Department of Obstetrics and Gynecology, Vmmc and Safdarjung Hospital, New Delhi, India
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17
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Bellizzi S, Bassat Q, Ali MM, Sobel HL, Temmerman M. Effect of Puerperal Infections on Early Neonatal Mortality: A Secondary Analysis of Six Demographic and Health Surveys. PLoS One 2017; 12:e0170856. [PMID: 28122046 PMCID: PMC5266333 DOI: 10.1371/journal.pone.0170856] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour. Methods The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990–2013 systematic analysis for the Global Burden of Disease Study. Results Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4–3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0–26.6) in Honduras to 3.6% (95% CI: 1.0–8.5) in Indonesia. Conclusions Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.
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Affiliation(s)
- Saverio Bellizzi
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
| | - Mohamed M. Ali
- World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
- * E-mail:
| | - Howard L. Sobel
- World Health Organization, Western Pacific Regional Office, Manila, Philippines
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
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