Maternal mortality and severe morbidity from sepsis in the Netherlands.

OBJECTIVE: To assess incidence and risk factors of maternal mortality and severe morbidity from sepsis in the Netherlands. DESIGN: A nationwide confidential enquiry into maternal mortality from 1993 to 2006 and severe maternal morbidity from 2004 to 2006. SETTING: All 98 Dutch maternity units in the Netherlands. POPULATION: All pregnant women in the Netherlands from 1993 to 2006. METHODS: All reported cases of maternal death from sepsis during 1993-2006 were reported to the Maternal Mortality Committee. Cases of severe maternal morbidity from sepsis from 2004 to 2006 were collected in a nationwide design. Main outcome measures. Incidence, case fatality rates, and possible risk factors. RESULTS: The maternal mortality ratio from direct maternal mortality from sepsis was 0.73 per 100,000 live births (20/2,742,265). The incidence of severe maternal morbidity from sepsis was 21 per 100,000 deliveries (78/371,021), of which 79% was admitted to the intensive care unit. High age, multiple pregnancies, and the use of artificial reproduction techniques were significant risk factors for developing sepsis in univariate analysis. The overall case fatality rate for sepsis during 2004-2006 was 7.7% (6/78). Group A streptococcal infection was in 42.9% (9/21), the cause of direct maternal mortality from sepsis (1993-2006). In 31.8% (14/44), Group A streptococcal infection was the cause of obstetric morbidity from sepsis (2004-2006). CONCLUSIONS: With a case fatality rate of 7.7%, sepsis is a life threatening condition for women during pregnancy, childbirth, and puerperium.

Secondary infertility caused by the retention of fetal bones after an abortion: a case report.

INTRODUCTION: Unwanted contraception through prolonged retention of fetal bone is a rare cause of secondary infertility. It is usually associated with a history of abortion, either spontaneous or induced. CASE PRESENTATION: We describe a case of intrauterine retention of fetal bone diagnosed 8 years after the termination of a pregnancy. The patient had no complaints of pain, irregular vaginal bleeding or discharge. A hysteroscopy was performed and irregular structures were removed. These fragments were fetal bones, which probably functioned as an intrauterine contraceptive device. After removal of the fetal bone fragments the patient conceived spontaneously within 6 months. CONCLUSION: This case report stresses the importance of taking a thorough history and evaluation of the endometrium by transvaginal ultrasound or hysteroscopy in women with secondary infertility.