Risk factors and microbial isolates of puerperal sepsis at the University of Maiduguri Teaching Hospital, Maiduguri, North-eastern Nigeria.
ABSTRACT To determine the risk factors and microbial isolates of puerperal sepsis.
A 12 year retrospective review of patients with puerperal sepsis from January 1999 to December 2010 at the University of Maiduguri Teaching Hospital (UMTH) was conducted. Information on socio-demographic characteristics, clinical presentations, place and mode of delivery and microorganism isolated from the endocervical swabs was collected and analysed. Comparison was also made with the other women that delivered during the period of study.
The incidence of puerperal sepsis was 0.78%. Majority (88.0%) of the patients were unbooked, 59.1% delivered at home and 23.1% delivered in other peripheral hospitals. The major risk factors for developing puerperal sepsis were unbooked status, home delivery, perineal trauma, caesarean section (C/S) and maternal age <24 years with OR of 56.60, 39.25, 8.52, 4.99 and 1.32, respectively. The commonest microorganism isolated were Staphylococcus aureus and Escherichia coli seen in 35.4 and 20.9%, respectively. Streptococcus species was found in 6.9%, while 20.3% had polymicrobials isolated.
Puerperal sepsis continues to present a significant risk of maternal mortality in developing countries. The risk factors are unbooked women, home delivery, perineal trauma, caesarean section and maternal age <24 years. S. aureus and E. coli are the commonest isolated organisms. There is a need to enlighten the populace on the need for booking, skilled attendant at delivery and hospital delivery under aseptic conditions.
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ABSTRACT: To estimate the incidence and predictors of severe obstetric morbidity. Development of definitions of severe obstetric morbidity by literature review. Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case. All 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998. 48 865 women who delivered during the time frame. There were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment. Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.BMJ 06/2001; 322(7294):1089-93; discussion 1093-4. · 14.09 Impact Factor
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ABSTRACT: Nine genera of microbes isolated from the lower genital tract of 187 women in labour in Zaria have been identified. The work was undertaken to establish the nature of microorganisms in the lower genital tract of women in labour as a basis for further study. The isolates in order of prevalence were: Candida albicans (20.9%), Klebsiella sp (15.0%), Escherichia coli (9.1%), Streptococcus faecalis (6.4%), haemolytic streptococci (other than Streptococcus pyogenes (2.7%), Streptococcus viridans (2.1%), Staphylococcus aureus (2.1%), Aeromonas hydrophila (2.1%), Proteus mirabilis (1.1%), Peptostreptococcus putridus (1.1%), Streptococcus pyogenes (0.5%), and Streptococcus pneumoniae (0.5%). Neisseria gonorrhoeae, Haemophilus sp, Lactobacillus sp, and Clostridium sp were sought but not found. Chlamydia, viruses, and T-strains of mycoplasma and trichomonas were not sought. It appears from this study that the lower genital tract of most women in Zaria at the time of labour is heavily colonised by pathogens. For this reason alone prolonged labour and trauma to the genital tract at the time of delivery should be avoided.Journal of Clinical Pathology 02/1981; 34(1):82-3. · 2.44 Impact Factor
- International Journal of Gynecology & Obstetrics 05/1998; 61(1):59-62. · 1.84 Impact Factor