A study of predisposing factors and microbial flora in puerperal sepsis

Abstract

Background: Puerperal sepsis is the third or fourth leading cause of maternal death worldwide with maternal mortality due to infections being as high as 15%6 with maternal morbidity being 8.1%7. Meticulous aseptic techniques, modern investigative tools and use of prophylactic antibiotics have reduced the incidence of puerperal sepsis in the developed countries however it still continues as a major cause of maternal morbidity and mortality in the developing countries. Methods: This was a retrospective study over a period of 18 months from July 2010 to December 2011 which included all the post natal patients admitted in the obstetrics ward of our hospital. All the patients who fulfilled the ICD 10 criteria of puerperal pyrexia were studied for the booking status, parity, mode of delivery, maternal anemia, number of PV examinations and duration of rupture of membranes. In addition vaginal swab culture and sensitivity of these cases was analysed. The results were calculated by statistical analysis and odds ratio calculated with 95% confidence interval. Results: The incidence of puerperal sepsis was 8.68% and was responsible for 60.29% of cases of puerperal pyrexia. The common predisposing factors were unbooked status, primiparity, caesarean section, anaemia, frequent PV examination and prolonged rupture of membranes. The most common microorganisms in vaginal swab culture and sensitivity were S. aureus (36%) and E. coli (29.8%). Conclusions: Puerperal sepsis is by and large a preventable cause of maternal morbidity and mortality. From our study and review of literature we conclude that early booking of all the antenatal cases, correction of maternal anemia, better aseptic conditions, deferring undue PV examinations, recognition of all the high risk cases and prophylactic administration of ampicillin and gentamycin can go a long way in preventing puerperal sepsis.