Puerperal Sepsis: An Outcome of Suboptimal Obstetric Care

OBJECTIVE: To determine the frequency, causative factors and outcome of delivery by trained or untrained personnel. STUDY DESIGN: Descriptive study. SETTING: This study was done in the Gynaecology / Obstetric Unit-II, Liaquat University Hospital, Hyderabad Pakistan from 1st January 2006 to 30th December 2006. PATIENTS AND MEHTODS: All the patients who developed puerperal sepsis, delivered out side the university hospital were included in this study, while those who were referred as a case of retained placenta, other obstetric related postpartum morbidities like anaemia, puerperal psychosis, breast abscess, UTI, or who developed postoperative surgical problem delivered at university hospital were excluded from study. RESULTS: Out of total 2885 maternal admissions 135 patients had various postpartum problems, 61 patients had puerperal sepsis. Majority (67.2%) was less than 30 years of age and 52.5% of low parity. Among study population 67.2% belonged to low scio-economic group and 96% were illiterate. Majority (67%) of women did not receive any level of care, only 9.8% had level 3 care. Patients who had vaginal delivery were 93.4% while 6.6% had caesarean section. In majority of patients (57.4%) high grade fever was the major symptom followed by distension of abdomen in 26.2%. Evacuation of uterus and laparotomy were done in 39.3%, only evacuation of uterus was carried out in 24.6% and 3.3% had hysterectomy. One third (32.8%) had prolonged hospital stay and other one third (32.8%) died inspite of all possible measures. CONCLUSION: The study conclude that in majority of women sepsis as well as maternal death was preventable. It can be reduced by proper counseling of women about importance of antepartum, intrapartum and postpartum care and training of Dais and refreshing courses of trained birth attendants (TBAs).