Maternal mortality due to sepsis after caesarean section at Chris Hani Baragwanath Hospital from 1997-2014
Dlamini, Zandile Barbara
Background Pregnancy related sepsis is one of the leading direct causes of preventable maternal morbidity and mortality. Evidence shows that caesarean section increases the risk of developing sepsis threefold compared to vaginal deliveries. Maternal death from sepsis after caesarean section can be prevented by proper monitoring of patients from the antenatal period, during labour and delivery and by early recognition and aggressive treatment of puerperal sepsis. This study was conducted to determine the frequency of maternal death from sepsis after caesarean section at Chris Hani Baragwanath Academic Hospital, and to identify associated factors including the role of HIV infection. Methods This was a retrospective descriptive study of maternal death due to sepsis after caesarean section at Chris Hani Baragwanath Academic Hospital from January 1997 to December 2014. Maternal death records of women who died of sepsis after caesarean section were obtained from the maternal death data base in the Department of Obstetrics and Gynaecology at the hospital. Results There were 108 299 caesarean sections performed during the study period, and 24 women died from sepsis after caesarean section from 1997 to 2014. These deaths made up 3.6% of the 661 maternal deaths at the hospital in this period. Three women presented as referrals, and 21 had their operations done at Chris Hani Baragwanath. The frequency of maternal death from sepsis after caesarean section at the hospital was 0.02% or 19.4/100 000 caesarean sections. The mean age of the women was 28.8 years, with three (12.5%) less than 20 years of age. Twenty women (83.3%) had emergency caesareans. The most common indication for caesarean section was Prolonged labour (50%). Sixteen (66.7%) women were HIV-infected. Twenty women (83.3%) required surgical intervention for puerperal sepsis after caesarean section. Conclusion On average, one to two women die each year at Chris Hani Baragwanath Academic Hospital from puerperal sepsis associated with caesarean section. This study showed that sepsis after caesarean section was more commonly observed with emergency than with elective procedures, and that prolonged labour was the most frequently associated obstetric indication. HIV infected women were more susceptible to death from sepsis after caesarean section, compared with HIV uninfected women. Obstetricians and midwives need to be skilled in the prevention, identification and treatment of life-threatening sepsis after caesarean section.
research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Obstetrics and Gynaecology Johannesburg, July 2017.