Magnitude and Risk Factors for Puerperal Sepsis at the Pumwani Maternity Hospital.

Abstract

Background: Puerperal sepsis is the third commeonest cause of maternal mortality in the world. It remains one of the leading preventable causes of maternal mortality, despite advances in modern medicine. Puerperal sepsis is defined as any infection occurring in a woman between the onset of labour or rupture of membranes to 42 days postpartum. Maternal complications as a result of puerperal sepsis include septicaemia, endotoxic shock and peritonitis or abscess formation leading to surgery and compromised future fertility. Given its significant burden in terms of morbidity, mortality and cost implications on the heath budget, studies on hospital specific incidences and patterns are important to help inform policy for its prevention. Objective: This study was conducted to determine the magnitude of, and factors associated with puerperal sepsis at Pumwani Maternity Hospital, Kenya. Methodology: A descriptive cohort of 793 consenting women were followed over two weeks to determine the magnitude of puerperal sepsis among women who delivered at Pumwani Maternity Hospital (PMH) in Nairobi, between March to November 2015. A case cohort was then analysed, in which 69 women who met the predetermined criteria for puerperal sepsis within the two week follow-up period were compared, each, to 3 controls selected for each case from the descriptive cohort Data was collected using an interviewer administered questionnaire, in which data from patients’ records were obtained at baseline and in the two week follow-up period. Socio-demographic, antenatal and intrapartum details were obtained at day one and those in whom infection was suspected were excluded. Data was cleaned, coded, and entered into STATA. The measure of association between the independent and dependent variables was the odds ratio and the corresponding 95% confidence interval. A p-value of <0.05 denoted significant association. Results: Seven hundred and ninety three postnatal mothers at Pumwani maternity hospital were recruited for the study. At two weeks follow-up, data from 566 of the 793 women was obtained, representing a loss to follow up of 28.6% (227/793). 69 women among the 566 met the criteria for puerperal sepsis. This corresponded to a magnitude of 12.2% at two weeks post partum(95% CI 9.5 – 14.9%). Further analysis of the case cohort was done using 69 cases each with 3 randomly selected controls. Therefore, a total of 276 women formed the analysis in the case cohort. No deaths were reported. Risk factors included labour lasting >24hours, c/section, obstructed labour, and multiple vaginal examinations. No significant association was noted with anaemia, HIV, and other co-morbidities. 2 Conclusion: The magnitude of puerperal sepsis at two weeks postpartum at Pumwani, was at 12.2%(95% CI 9.5-14.9). Two or more vaginal examinations, prolonged and obstructed labour, and caesarian section were found to be significantly associated with an increased risk. Appropriate measures like proper use of the partograph, should be put to use in order to prevent prolonged and obstructed labour. Reduction in the number of vaginal examinations is recommended. In those with more than 2 vaginal examinations done, universal precautions and antibiotic prophylaxis should be made. Further studies on adherence to guidelines, infection prevention and control may be done.