Number of Bleeding, Placenta Remaining, and Episiotomy Actions on the Incidence of Puerperal Sepsis

It is estimated that 60% of maternal mortality resulting from gestation happened right after giving birth, and 50% of puerperium deaths happened in the first 24 hours. This research aims to know the relation between the amount of bleeding, remaining placenta, and the act of episiotomy to puerperal sepsis cases. This research uses analytical description methods with a cross-sectional approach. The population of this research was the postpartum mothers in puerperal sepsis cases in October – December 2017 at RSAB Harapan Kita Jakarta Barat counted 85 persons. The sampling method used in this research is an accidental sampling method with 32 respondents. The Instruments of this research are medical records and questionnaires with the chi-square analysis method. This research data analysis has the quality of univariate and bivariate, which means knowing about the relation between the amount of bleeding, remaining placenta, and the act of episiotomy to puerperal sepsis cases. This research shows a relation between the amount of bleeding with a p-value (0,035) and OR (7,200). There is a relation between remained placenta variable with a p-value (0,035) and OR (7,200). There is no relation in the act of episiotomy variable with p-value (0,142) and OR (3,500) to puerperal sepsis cases. The researcher suggests RSAB Harapan Kita increase the quality of their health services, mainly socialize information and give education for maternity women about various birth complications, such as bleeding and remaining placenta and sepsis puerperalis's risks.

Burden of puerperal sepsis and its associated factors in Ethiopia: a systematic review and meta-analysis

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.

Spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery presenting as puerperal sepsis

Spontaneous isolated intraperitoneal rupture of urinary bladder is a rare urological complication of normal delivery. This complication is usually related to prolonged labour, failure to empty bladder in second stage of labour, use of forceps/ ventouse, postpartum urinary retention, vaginal birth after caesarean section and usually presents immediately after delivery. We report the case of a patient with spontaneous isolated intraperitoneal rupture of urinary bladder after normal vaginal delivery in the absence of any risk factor. She presented on day 5 postpartum with features suggestive of puerperal sepsis with pyoperitoneum with acute kidney injury. Absence of unhealthy lochia and later, normal-looking uterus and adnexa during laparotomy led to the suspicion of alternate cause for seropurulent ascites. Further exploration revealed rent in the urinary bladder with necrosed margins. High index of suspicion of alternate diagnosis should be maintained if some of the clinical findings are not supportive of provisional initial diagnosis

Risk factors and Compliance of surviving sepsis campaign: A retrospective cohort study at tertiary care hospital

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. doi: https://doi.org/10.12669/pjms.38.1.3992 How to cite this: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(1):---------. doi: https://doi.org/10.12669/pjms.38.1.3992 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

731. Puerperal Sepsis Among Women with In-facility Births in Western Tanzania

Background Puerperal sepsis is an important cause of maternal mortality worldwide. As access to emergency obstetric services expands in resource-limited settings, rapid recognition and treatment of sepsis, and prevention of nosocomial infections that might lead to sepsis, is critical. We describe puerperal sepsis cases among women with in-facility births in the Kigoma region of Tanzania. Methods Demographic, obstetric history, pregnancy complication and outcome, as well as mortality data were collected for women who delivered in hospitals, health centers and dispensaries in the Kigoma region, Tanzania 2016 – 2018. Up to 3 maternal complications were recorded as free text. Puerperal sepsis included women where ‘sepsis’ was recorded as a complication during hospitalization. We calculated rates of puerperal sepsis and completed a descriptive analysis of patients. Results 203,604 women delivered infants in 197 participating facilities during the data collection period. Of these, 2228 (1.1%) had sepsis recorded, for an overall rate of 10.9 sepsis cases per 1000 deliveries. Although 48% of births occurred in dispensaries, sepsis complications were reported almost exclusively in hospitals and health centers (37.7 and 10.3 per 1000 deliveries, respectively). Sepsis rates varied across individual facilities, from 15.5 to 45.2 cases per 1000 deliveries in hospitals and 0 to 38.6 cases per 1000 deliveries in health centers. Women who developed sepsis had a median age of 25 (IQR 22 – 30) years and 1113 (56%) were nulliparous. 1763 (90%) of women who had sepsis delivered by caesarian delivery. Obstructed labor (827; 42%) was a common co-complication of sepsis; obstetric hemorrhage and uterine rupture were seen in 93 (5%) and 77 (4%) women with sepsis, respectively. 49 women with sepsis (3%) died prior to hospital discharge. Stillbirths and pre-discharge neonatal deaths complicated 107 (5%) and 74 (4%) deliveries to women with sepsis. Conclusion In the Kigoma region of Tanzania puerperal sepsis frequently occurs in women with obstructed labor and caesarian delivery. Further evaluation of both facility-level and individual factors that contribute to the incidence of sepsis in this population, particularly those related to invasive procedures, is critical for early recognition and prevention. issue Disclosures All Authors: No reported disclosures

Effectiveness of Information Booklet on Knowledge Regarding Puerperal Sepsis and Its Prevention among Nurses Working in Selected Hospitals of Kamrup (M), Assam: An Evaluative Study

Background: Puerperal sepsis is a postpartum complication, occurs when a recently delivered mother gets an infection while giving birth due to unhygienic practices and poor quality healthcare. If not treated properly in time may lead to death. Lack of awareness among healthcare providers can lead to higher rates of infection. Objective: To assess the effectiveness of information booklet on knowledge regarding puerperal sepsis and its prevention among nurses working in selected hospitals of Kamrup (M), Assam. Methods: The pre experimental one group pre-test post-test research designed was adopted in the study. 100 nurses were selected as sample by using convenience sampling technique in selected hospitals of Kamrup (M), Assam. To assess the nurses’ knowledge regarding puerperal sepsis and its prevention structured knowledge questionnaire was used. Results: In pre-test, the mean knowledge score was 11.76 with standard deviation 2.90. In post-test, the mean knowledge score was 19.81 with standard deviation 1.96. The calculated paired t test value of t = 33.352 was found to be statistically significant at p<0.001. Hence, information booklet on puerperal sepsis was found to be effective in improving the knowledge regarding puerperal sepsis and its prevention. There was significant association between pre-test knowledge regarding puerperal sepsis and its prevention and educational qualification. Conclusions: Majority of the nurses gained knowledge after referring the information booklet. Hence, awareness program in regular period will help in improving knowledge regarding puerperal sepsis among nurses to provide quality health care for a healthy society. Key words: Knowledge, Information booklet, puerperal sepsis, prevention.

A Five-year Review of Puerperal Sepsis and Its Complications at the Federal Medical Centre, Yenagoa, South-South Nigeria

Background: Puerperal sepsis is a significant cause of maternal morbidity and mortality, especially in developing countries, Nigeria inclusive. It complicates 1% – 8% of all deliveries, and is responsible for 15% of maternal deaths. Objective: To determine the incidence of puerperal sepsis, and its associated complications at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria, over a five-year period. Materials and Methods: This retrospective survey was carried out between 1st January, 2016, and 31st December, 2020. Data were retrieved, entered into a pre-designed proforma, and analyzed using IBM SPSS version 25.0. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables. Results: A total of 66 women were managed for puerperal sepsis out of 4,571 obstetric patients seen in the five-year period under review. Most women were unbooked (81.8%), and were delivered at home/unorthodox faith-based delivery units by traditional birth attendants (75.8%). Staphylococcus aureus, Escherichia coli and Klebsiella spp were cultured in 54.8%, 12.9% and 12.9% of cases, respectively. There was no maternal mortality. Conclusion: Puerperal sepsis remains an important public health problem in developing countries. While encouraging antenatal care and supervised hospital delivery is important for its primary prevention, early diagnosis, prompt and effective antibiotic and supportive therapy will prevent its complications.

“MATERNAL OUTCOME IN PREGNANCY WITH THROMBOCYTOPENIA”

INTRODUCTIONThrombocytopenia is diagnosed when the platelet count is less than 1,50,000 per microliter of blood It is a common hematological disorder Thrombocytopenia is divided into 3 types according to severity: mild (100,000 to 150,000), moderate (50,000to100,000) and severe (less than 50,000) thrombocytopenia. MATERIALAND METHODObjective- To study the incidence of thrombocytopenia in normal pregnancy. to study the maternal and fetal outcomes in pregnant patients with thrombocytopenia This is a retrospective study in which a total of 1202 patients delivered in a maternity hospital of Gwalior from 1 January 2018 to 30 June 2019 were studied. 72 patients with a platelet count below 1.5 lakhs were included in the study. RESULTSA total of 1202 patients were delivered during the study period out of the 72 patient had thrombocytopenia thus the prevalence was found to be 5.99%. rd In our study majority of the patients were multigravida 63.88% in the 3 trimester 54.16% majority by between age of 25-30 years 58.33%. In our study 61.11% of women had mild, 27.77 had moderate and 11.11% had severe thrombocytopenia. In this study, gestational thrombocytopenia was the most common etiological factor with 29.16% of cases. In our study, 70.83% of patients were delivered vaginally and 29.16% of patients were delivered by LSCS. No complication was reported in 48.61% of patients. The bleeding during CS was found in 4.16% cases, maternal hemorrhage was found in 5.55%, pulmonary edema in 5.55%, ARF in 5.55%, DIC 4.16%, and Puerperal sepsis in 2.77%. Blood transfusion was needed in 15.27% of patients, platelet transfusion in 4.16% of patients. Obstetric hysterectomy was done in 1 patient. During the study, 2 maternal death were reported due to the HELLPsyndrome and associated complications. CONCLUSIONGestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy. We conclude that early diagnosis of thrombocytopenia in pregnancy is essential for better maternal and fetal outcomes. It is important to determine the exact etiological cause of thrombocytopenia so that timely management can be provided to the pregnant patients to decrease the complication rate thus, timely diagnosis, frequent monitoring, and treatment is must achieve a better outcome.