Severe Puerperal Sepsis-A Simmering Menace

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.www.jcdr.net Sheeba Marwah et al., Severe Puerperal Sepsis-a Simmering Menace

Managing dyspnea in pregnancy-an errand uphill: an experience from the critical care obstetric unit of a tertiary care facility in India

“…18,19 This was in consonance of the findings of few past pollsters who have suggested that delivery may improve maternal status in ventilated women, and some authors have suggested elective delivery for women in late pregnancy who have ARDS but are clinically stable (5, 94). However, others have stated that given the risks of inducing labor or performing a cesarean, the indications for delivery in such women should be obstetric.…”

“…It also supports maintenance of hygiene and asepsis by doctors and midwifery, besides upgrading of their knowledge up-to-date with new-fangled protocols in infection control in pregnant population. 19 Unlike the western literature, very few women had asthma exacerbations during their pregnancy. [20][21][22][23] This can be ascribed to the largely rural population coming to the hospital for their antenatal care.…”

Risk factors, changes in serum inflammatory factors, and clinical prevention and control measures for puerperal infection

“…During pregnancy, it is suggested that early pregnancy be determined in time, health management during pregnancy be actively implemented, the standard maternal manual be created before 13 weeks of gestation, the comprehensive physical examination be given, and high‐risk pregnancy and pathologic pregnancy be screened to improve the safety of pregnancy. During delivery, sterile operations should be strictly performed, the digital anal examination is strictly forbidden, the frequency of vaginal examination should be reduced as far as possible to reduce the incidence rate of retrograde infection, indications of cesarean section and lateral episiotomy should be strictly grasped, antibacterial drugs can be used for a short time for those undergoing cesarean section to prevent the infection, and the maternal management should be strengthened to improve the hospital delivery rate, prevent postpartum hemorrhage, and reduce the injury of birth canal due to delivery as far as possible . During puerperium, it is recommended that puerperae get enough sleep, strengthen nutrition reasonably, and improve the body's immunity, the health management be strengthened, and prevention measures be actively taken for puerperae with high‐risk factors, thereby improving the prognosis of patients and reducing the incidence of puerperal infection .…”

Clinical Presentation and Mortality of Women Presented with Puerperal Sepsis at Tertiary Care Hospital

“…P. sepsis seems to be the world's third leading factor for maternal fatalities following hypertension and hemorrhage, and the 2nd leading factor in Asians and Africans following hemorrhage [2]. P. sepsis is a sepsis acquired by females during or shortly after miscarriage or childbirth [3,4]. It is an assemblage of fever symptoms and additional indications of pelvic discomfort, vaginal discharge with foul-smell, and uterus subinvolution during sepsis.…”

“…It is an assemblage of fever symptoms and additional indications of pelvic discomfort, vaginal discharge with foul-smell, and uterus subinvolution during sepsis. Sepsis, together with its clinical symptoms, is characterized as infection [3]. Serious sepsis is described as a potentially dangerous disease characterized by systemic inflammation syndrome accompanied by organ dysfunction, infection, hypotension or hypoperfusion [3,5].…”