PUERPERAL SEPSIS —STILL A MAJOR THREAT FOR PARTURIENT
AbstractBackground: Puerperal sepsis is one of the leading causes of preventable maternal morbidity andmortality. It is still ranked as 3rd major cause of maternal deaths in our country. The objective of thisstudy was to evaluate morbidity and mortality from puerperal sepsis and to identify its risk factors.Methods: This observational study was carried out in Ayub Teaching Hospital over a period of threeyears. All patients admitted with diagnosis of puerperal sepsis secondary to genital tract infection wereevaluated with thorough details of history and examination to determine their demographic details,obstetrical profiles, presenting features, state of infectious morbidity, need for intervention andmortality related to puerperal sepsis. Results: Puerperal sepsis was 1.7% of all obstetrical admissionsand 34.4% of postnatal complications. It was seen common among young patients of 15–25 years age,61 (66.3%), of lower parity, 58 (63.00%), low socioeconomic status, 60 (65.20%), uneducated patients,72 (78.20%), home deliveries, 68 (73.90%), prolong labour, 54 (58.60), prolong rupture of membranesfrom 48–72 hours, 68 (73.8%) and deliveries conducted by untrained birth attendants, 57 (60.5%).Puerperal sepsis morbidity was mostly foul smelling discharge, 23 (25%), retained product ofconception, 41 (44.5%), peritonitis, 8 (8.60%), septicaemia, 4 (4.3%), pelvic abscess, 10 (10.80%),endotoxic shock, 4 (4.30%), disseminated intravascular coagulation, 2 (2.1%). Sepsis related mortalitywas 6/42 (14.2%). Conclusion: Puerperal sepsis is an important public health problem contributing tomaternal morbidity and mortality. Majority of predisposing factors are preventable. Optimal antisepticmeasures and careful monitoring are needed throughout the process of labour.Keywords: Puerperal sepsis, Maternal mortality, Rupture of membranes, Obstructed labour,Traditional birth attendant, TBA, disseminated intravascular coagulation, DIC
Maharaj D. Puerperal pyrexia: a review part II. Obstet Gynecol
Akbar N, Shami N, Asif S. Maternal mortality in tertiary care
teaching hospital. J Coll Physician Surgeons Pak
Lowdin I. Deaths in child bed from the 18th century to 1935. Med
De Costa CM. The Contagiousness of Childbed Fever: a short
history of Puerperal Sepsis and its treatment. Med J Aust
Gourlay M, Gutierrez C, Chong A, MD, Robertson R. Group A
Streptococcal Sepsis and Ovarian Vein Thrombosis after an
Uncomplicated Vagina Delivery. JABFP 2001;14:375–80.
Carla Abou Zahr. Global burden of maternal death and disability.
British medical Bulletin 2003;67(1):1–11.
Glanzer CM, MacArthur C. Post natal morbidity. Obstet
Carter, KC, Barbara R. Carter. Childbed fever. A scientific
biography of Ignaz Semmelweis. Transaction Publishers;
Gwyneth Lewis (ed). Saving Mothers Lives: Reviewing
maternal deaths to make motherhood safer-2003–2005. The
Seventh Report of the Confidential Enquiries in to Maternal
Deaths in the United Kingdom. Available at:
http://www.cemach.org.uk/getattachment/8f5c 1 ed8-fdf3-
_full.aspx ISBN 978-0-9533536-8-2. p.97.
Faiza I. Maternal Mortality. In the Review Dawn News Paper
Karachi Pakistan, 25th–31st Jan 2007. P. 5.
Murray CJL, Lopez AD. Quantifying the health risks of sex and
reproduction: Implications of alternative definitions. In: Murray
CJL Lopez AD, eds. Health dimensions of sex and reproduction :
the global burden of sexually transmitted disease, HIV, maternal
conditions, perinatal disorders, and congenital anomalies
Cambridge, MA, Harvard School of Public Health on behalf of
the World Health Organization and World Bank, ( global burden
of disease and injury Series, No. III);1998. p.1–17.
Riaz GS. Revised approach in the management of puerperal
sepsis. Specialist 1992;8(3):51–4.
Talat N, Nabeel A, Naueen A. Patients with postpartum
complications admitted in a medical ward of Mayo Hospital,
Lahore. Pak J Med Sci 2002;18(2):126–30.
Vallely L, Ahmed Y, Murray SF. Postpartum maternal morbidity
requiring hospital admission in Lusaka, Zambia- a descriptive
study. BMC Pregnancy and Childbirth 2005;5:1
doi:10.1186/1471-2393-5-1.Electronic version. Available at
deGroot, Makapoo MS. Saving mothers Interim Report on
Confidential inquiries in to maternal deaths in South Africa 1998
(by National Committee for Confidential Inquiries in to maternal
deaths. Available at: http://www.doh.gov.za/docs/reports/1998/
Chatterjee M. Indian women, their health and economic
productivity. (World Bank discussion papers, No. 109)
Washington DC: World Bank; 1990.
Mustafa R, Rizwan N, Qazi Y. Puerperal sepsis: An outcome of
Suboptimal Obstetric Care. J Liaquat Uni Med Health Sci
Largo M, Liche A, Mumba T, Ntebka R, Van Roosmalen J.
Postpartum health among rural Zimbabwean. Afr J Reprod
State of maternal, child health poorer in Pakistan, Sunday Dec
, 2008, by Qasim M. Islamabad National Programs for
maternal and newborn. Available at:
Posthinam S, Chanpoo T, Lumbiganon P. Post Cesarean Section
Puerperal morbidity. The incidence and risk factors at
Srinagarind Hospital. J Med Assoc Thai 1992;75(3):173–7.
Graham W, Bell J, Bullough CH, Can skilled attendance at
delivery reduces maternal morbidity in developing countries? In:
De Brougwere V, Van Lerberghe W, eds. Safe motherhood
Strategies. A review of the evidence. Antwerp ITG Press; 2001.
(Studies in health services organization and policy), 17:91–131.
Mosha F, Winani S, Wood S, Changalucha J, Ngasalla B.
Evaluation of the effectiveness of a clean delivery kit intervention
in preventing cord infection and puerperal sepsis among newborn
and their mothers in rural Mwanza Region, Tanzania. Tanzania
Health Res bull 2005;7(3):185–8.
Ahmad N, Mehboob R. A study of cesarean birth in a teaching
hospital. Pak J Med Res 2002;41(3):118–22.
Simoes E, Kunz S, Bosing-Schwenkglenks M, Schmahl FW.
Association between method of delivery and puerperal infections
complications in the perinatal database of Baden Württemberg
–2001. Gynecol Obstet Invest 2005;60(4):213–7.
Neilson JP, Lavender T, Quenby S, Wray S. Obstructed labour:
Reducing maternal death and disability during pregnancy. Br
Med Bull 2003;67(1):191–204.
Kaori S, Keizo S, Ken N, Kanji H, Hirofumi K, Masayoshi N,
Masami N. Five cases of puerperal sepsis. Jap J Obstet Gynecol
Neonat Hematol 2001;10:(2):48–55.
El-Mahally AA, Kharboush IF, Amer NH, Hussein M, Abdel
Saam T, Youssef AA. Risk factors of puerperal sepsis in
Alexandria. Egypt Public Health Assoc 2004;79(3–4):311–31.
Vacca A, Handerson A. Puerperal sepsis in Port Moresby, Papua
New Guinea. P N G Med J 1980;23(3):120–5.
Melah GS, El-Nafaty AU, Massa AA, Audu BM. Obstructed
labour: a public health problem in Gombe, Gombe State, Nigeria.
J Obstet Gynaecol 2003;23(4):369–73.
Ozumba BC, Uchegbu H. Incidence and management of
obstructed labour in eastern Nigeria. Aust N Z J Obstet Gynaecol
Begum S, Aziz-un-Nisa, Begum I. Analysis of maternal
mortality in a tertiary care hospital to determine causes and
J Ayub Med Coll Abbottabad 2010;22(3)
preventable factors. J Ayub Med Coll Abbottabad
Reduction of maternal mortality; a joint
WHO/UNFPA/UNICEF/World Bank Statement. Geneva Word
Jafary S, Ahsan A, Kamal I. Manual for emergency obstetrics
care, UNICEF/National Committee for Maternal heath. 2002:22.
Manreen C. The global incidence of puerperal sepsis. Geneva
Foundation for Medical education and Research. [Electronic]
Available from: http://www.gfmer.ch/
Rehana R, Tanveer S, Nasreen R. An Analysis of direct causes of
maternal mortality.J Postgrad Med Ins 2006;20(1):86–91.
Nusrat S, Nusrat H. Khan. Third delay of maternal mortality in a
tertiary care hospital. Rawal Med J 2007; 32 (2):163–7.
Bryan HB, Anderson Mary M, Drife James O. Report on
Confidential inquiries in to maternal deaths in U.K. (1988 1990),
UK: Stationary Office Books; 1994.p.15–8.