A retrospective study on the outcomes of peripartum hysterectomies for puerperal sepsis at Chris Hani Baragwanath Academic Hospital

dc.contributor.authorOlusola, Esther
dc.contributor.supervisorNaidoo, Poovangela
dc.date.accessioned2025-04-15T12:20:39Z
dc.date.issued2024
dc.descriptionA research report Submitted in fulfillment of the requirements for a Master of Medicine, In the Faculty of Humanities , School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2024
dc.description.abstractBackground: Puerperal sepsis is a significant cause of maternal morbidity and mortality, especially in developing countries. Hysterectomy is often performed as a measure of source control for severe uterine infections when conservative treatment fails. The aim of this retrospective study was to examine the outcomes of peripartum hysterectomies performed for puerperal sepsis at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Methods: A retrospective cross-sectional study was conducted between 1 January and 31 December 2019, on all women who underwent hysterectomies for puerperal sepsis. Data pertaining to demographics, surgical characteristics, microbiological cultures, organ dysfunction scores, and histopathological findings, were extracted from medical records. Women with miscarriages or pregnancies less than 24 weeks’ gestation were excluded. Statistical analysis included descriptive methods and comparative tests using Stata 15.0 software. Organ dysfunction scores were calculated using MODS, SOFA, and qSOFA systems. Ethical approval was obtained prior to conduction of the study. Results: During the study period, 33 hysterectomies were performed for puerperal sepsis, representing 0.17% of the 18,458 deliveries at the hospital. The median age of women was 28 years of age with a median gestational age at delivery of 38 weeks. The majority (88%) underwent total abdominal hysterectomies, while 12% had subtotal hysterectomies. Eighty eight percent of women underwent caesarean section for a fetal distress. The most common organisms cultured in intra-abdominal fluid were Acinetobacter baumannii (26%), Escherichia coli (19%), Klebsiella species (14%) and Enterococcus faecalis (14%). A. baumannii was the predominant pathogen in all four culture mediums. The most common antibiotics used in this hospital for treatment were resistant against most organisms. Women with higher MODS and SOFA scores predominantly cultured resistant organisms. A. baumannii was strongly associated with worse outcomes. Two women (6%) died due to complications of ongoing sepsis. Histological examination revealed that surgeons often underestimated the extent of necrosis (30%) and presence of pus (44%), highlighting the importance of histopathological evaluation for accurate diagnosis and management. Conclusion: This study highlights the rising antibiotic resistance which complicates treatment and emphasises the need for revision of antibiotic stewardship in puerperal sepsis management. Women with higher MODS and SOFA scores predominantly cultured resistant organisms. Further research is required to explore improving surgical recognition of uterine sepsis and whether a total abdominal hysterectomy is actually superior to a subtotal hysterectomy in women with puerperal sepsis.
dc.description.submitterMM2025
dc.facultyFaculty of Health Sciences
dc.identifier0009-0003-7175-3958
dc.identifier.citationOlusola, Esther. (2024). A retrospective study on the outcomes of peripartum hysterectomies for puerperal sepsis at Chris Hani Baragwanath Academic Hospital [Masters dissertation, University of the Witwatersrand, Johannesburg]. WIReDSpace. https://hdl.handle.net/10539/44796
dc.identifier.urihttps://hdl.handle.net/10539/44796
dc.language.isoen
dc.publisherUniversity of the Witwatersrand, Johannesburg
dc.rights© 2024 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.
dc.rights.holderUniversity of the Witwatersrand, Johannesburg
dc.schoolSchool of Clinical Medicine
dc.subjectUCTD
dc.subjectPuerperal sepsis
dc.subjecthysterectomy
dc.subjectantibiotic resistance
dc.subjectmaternal mortality
dc.subjectMODS
dc.subjectSOFA
dc.subjectChris Hani Baragwanath Hospital
dc.subject.primarysdgSDG-3: Good health and well-being
dc.titleA retrospective study on the outcomes of peripartum hysterectomies for puerperal sepsis at Chris Hani Baragwanath Academic Hospital
dc.typeDissertation

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