Publication:

Puerperal sepsis and maternal outcome in developing countries: an observational study

Background Puerperal sepsis is a major cause of maternal morbidity, mortality. Present study was conducted to know burden of severe puerperal sepsis, risk factors, maternal outcome.

Methods Present observational cohort study was conducted in the Obstetrics and Gynecology department of rural tertiary center of Northern India over eight months (1st January-31st July 2018). All women who had delivered or aborted in an institution or those referred from outside within 42 days of delivery/abortion having clinical features, investigations suggestive of puerperal sepsis were enrolled. Socio-demographic factors, clinical features, examination findings, investigations, details of antecedent pregnancy, complications, risk factors, and maternal outcome were recorded. Statistical analysis was done using SPSS version 22 software.

Results A total of 66 cases with severe puerperal sepsis were observed during the study period of which 55 (83.3%) were referred from outside. The most common mode of delivery in antecedent pregnancy was vaginal (42.4%) followed by cesarean section (33.3%) and one (1.5%) forceps delivery. There were 15 (22.7%) post-abortal cases. Maternal anemia was found to be significantly linked with sepsis and adverse maternal outcome (p<0.05). Most common presenting features were fever (100%), tachycardia (100%), breathlessness (100%), malodourous vaginal discharge (100%), abdominal distention (53.0%), scar infection (16.7%), vaginal or rectal bleeding (16.7%), peritonitis (27.3%), septic shock (12.1%). A total of 38 (57.6%) cases required surgical intervention with seven (10.6%) developing multiorgan failure and 15 (22.7%) succumbed to death.

Conclusions Though puerperal sepsis is a preventable condition, it continues to be one of the major causes of maternal morbidity, mortality.