Sepsis Related Maternal Near Miss And Mortality In Low Income Country

Dr Fahmida Parveen, Dr Samia Aijaz

 Department of Obstetrics and Gynaecology Liaqat Univeristy Of Medical And Health Sciences Jamshoro, Hyderabad

Introduction

 Maternal morbidity and mortality (MMR) are global socioeconomic and health care burdens. It accounts for 10-15% deaths in postpartum period and continues to be leading cause of mortality in developing countries. Achieving  global MMR below 70 by year 2030 will require an annual rate of reduction of 11.6%. Maternal death  the most catastrophic  end is described as just “tip of the iceberg “whereas maternal near miss as base ,therefore Maternal Near Miss (MNM) is increasingly used  as an indicator of quality of obstetric care.

Objectives

The objective of my study was to  determine the burden and associated factors with  maternal near miss  and mortality  due to post natal infections at tertiary care public sector hospital.

Method

A cross sectional study conducted for one year. All the admitted women diagnosed with postnatal infection after vaginal delivery, C/Section and septic abortion , who met WHO “criteria for near miss” based on organ failure. Data was collected on predesigned proforma after patients written and informed consent. Data was entered and  analyzed on IBM SPSS version 23. Association  of parameters were tested using Pearson chi square  and Fisher’s Exact test.          P value < 0.05 were considered statistically significant.

Results

 Total 143 women included in study, 95.1% women identified as near miss and 4.9% were expired. Majority of women (53.1%)  were 25-36 years of age, belonged to rural areas (62.9%). Mostly uneducated, referred cases from primary and secondary care hospitals. 58.1% near miss and 71.4% maternal deaths cases have initial procedure of C/Section. There was a significant association of C/Section with maternal near miss and mortality (p<0.01). Major cause of postnatal infections were peritonitis (39.2%), wound infection (30.1%) and septic abortion (20.3%). (76.2%) received antibiotics before transfer to tertiary care hospital, that shows significant association with antibiotics resistance.

Conclusion

Cesarean/Section related peritonitis, septic abortion and antibiotics resistance were mainly associated with postnatal infections. Local strategies and policies should be established and implemented to improve safety, quality and infection control for postnatal period of women.

References

1. Demisse GA  et al. Determinants of puerperal sepsis among post partum women at public hospitals in West SHOA zone Oromia regional STAT, Ethopia (institution BAEDCASE control study) BMC Pregnancy and Childbirth (2019) 19:95.

2.Chikadaya H et al. Incidence of maternal near miss in the public health sector of Harare, Zimbabwe: a prospective descriptive study.BMC Pregnancy and childbirth.2018; 18: 458.

3.Firoz T, Lionela C et al. Global and regional estimates of maternal near miss: a systematic review, meta-analysis and experiences with application. BMJ Global Health 7 (4), e007077,2022