Puerperal sepsis: presentation, management and outcome: a hospital based study

ABSTRACT

Puerperal sepsis is a major cause of morbidity and mortality in Pakistan, but due to scarce data its magnitude is underestimated. To describe the presentation, management, and outcome in patients admitted with puerperal sepsis. Descriptive prospective study, carried out at Gynae/Obs Unit-1 of Ghulam Mohammad Mahar Medical College Hospital, Sukkur from 1[st] July 2007 to 31[st] December 2009. All the patients who met with the criteria of puerperal sepsis i.e. high grade temperature more than 38 °C, foul smelling vaginal discharge, open perineal wound / abdominal stitches were included in the study. The patients presenting with other postpartum obstetric reasons like post-partum haemorrhage, urinary tract infection, Mastitis, retained placenta were excluded. A total of 245 patients were admitted for postpartum problems, of whom 144[59%] were diagnosed as puerperal sepsis. Majority 122[85%] of the cases were between 21-40 years age, and multiparas were at a higher risk. Mode of delivery was vaginal in 133[92.4%] patients, while delivery was conducted at home by untrained birth attendants in 113[78%] patients. Anemia and prolonged neglected labour were commonly reported problems while, common presenting symptoms included high grade fever in 137[95%], foul smelling vaginal discharge in 46[32%], and abdominal distension in 32[22%] cases. More serious presentations like septicemia, multiple organ failure were seen in 26[18%] cases. Besides, antibiotics, 24[16.6%] needed dilatation and evacuation while, laparotomy was performed in 15[10.4%]. Mortality was seen in 18[12.5%] cases while, 28[19.4%] had prolonged hospital stay > 8 days. Puerperal sepsis is a leading cause of maternal morbidity and mortality in our setup which can be controlled by proper antenatal care, delivery by trained birth attendants, early referral and good antibiotic cover. Trained birth attendants and health care providers should be trained to detect early signs and symptoms of puerperal sepsis and its prompt treatment in order to reduce maternal morbidity and mortality