Risk factors, microbiology and clinical outcomes of puerperal sepsis.

Abstract

Objective: To determine the factors leading to the development puerperal sepsis. A secondary objective was to determine the pattern of bacterial spectrum in-hospital mortality to puerperal sepsis in our local population. Study Design: Descriptive Cross-sectional study. Setting: A Tertiary Care Hospital Department of Gynaecology and Obstetrics, Unit 3, Civil Hospital Karachi. Period: 4^th March 2022 to 22^nd September 2022. Methods: The study recruited post-delivery women with clinically diagnosis of puerperal sepsis. Socio-demographic, clinical and obstetric information, factors leading of termination of pregnancy and in-hospital mortality were collected. Results: 177 Puerperal sepsis patients presenting with fever, lower abdominal pain, and foul-smelling lochia were analysed. The average age of the patients was 30.2 (± 7.4) years, ranging between 20-45 years. Mean gestational age was 37.9 (± 3.4) weeks. Majority (85%) were delivered after 36 weeks. Risk factors for puerperal sepsis included caesarean section in 137 (77.4%), anaemia in 105(59.3%) and diabetes in 4 (7.9%). A total of 108 (61.1%) blood cultures were positive. The most common organism was staphylococci aureus (32.2%) followed by E. coli (14.7%), klebsiella pneumonia (7.9%) and streptococcus pyogenes (1.1%). Both pseudomonas and proteus were observed in 2.8% cases. It has observed that 16 (9%) died during hospital stay. Conclusion: Caesarean delivery, anaemia and diabetes were associated with high risk of puerperal sepsis. Most of the bacterial infection was found to be caused by Staphylococcus Aureus which accounted for 57 [32.2%].