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

Abstract

Puerperal sepsis is a significant cause of maternal morbidity and mortality, especially4 in developing countries. Hysterectomy is often performed as a measure of source5 control for severe uterine infections when conservative treatment fails. The aim of6 this retrospective study was to examine the outcomes of peripartum hysterectomies7 performed for puerperal sepsis at Chris Hani Baragwanath Academic Hospital,8 Johannesburg, South Africa.9 10 Methods:11 A retrospective cross-sectional study was conducted between 1 January and 3112 December 2019, on all women who underwent hysterectomies for puerperal sepsis.13 Data pertaining to demographics, surgical characteristics, microbiological cultures,14 organ dysfunction scores, and histopathological findings, were extracted from15 medical records. Women with miscarriages or pregnancies less than 24 weeks’16 gestation were excluded. Statistical analysis included descriptive methods and17 comparative tests using Stata 15.0 software. Organ dysfunction scores were18 calculated using MODS, SOFA, and qSOFA systems. Ethical approval was obtained19 prior to conduction of the study.20 21 Results:22 During the study period, 33 hysterectomies were performed for puerperal sepsis,23 representing 0.17% of the 18,458 deliveries at the hospital. The median age of24 women was 28 years of age with a median gestational age at delivery of 38 weeks.25 The majority (88%) underwent total abdominal hysterectomies, while 12% had26 subtotal hysterectomies. Eighty eight percent of women underwent caesarean27 section for a fetal distress. The most common organisms cultured in intra-abdominal28 fluid were Acinetobacter baumannii (26%), Escherichia coli (19%), Klebsiella species29 (14%) and Enterococcus faecalis (14%). A. baumannii was the predominant30 pathogen in all four culture mediums. The most common antibiotics used in this31 hospital for treatment were resistant against most organisms. Women with higher32 MODS and SOFA scores predominantly cultured resistant organisms. A. baumannii33 was strongly associated with worse outcomes. Two women (6%) died due to34 complications of ongoing sepsis. Histological examination revealed that surgeons35 often underestimated the extent of necrosis (30%) and presence of pus (44%),36 highlighting the importance of histopathological evaluation for accurate diagnosis37 and management.38 39 Conclusion:40 This study highlights the rising antibiotic resistance which complicates treatment and41 emphasises the need for revision of antibiotic stewardship in puerperal sepsis42 management. Women with higher MODS and SOFA scores predominantly cultured43 resistant organisms. Further research is required to explore improving surgical44 recognition of uterine sepsis and whether a total abdominal hysterectomy is actually45 superior to a subtotal hysterectomy in women with puerperal sepsis.46 47 Keywords:48 Puerperal sepsis, hysterectomy, antibiotic resistance, maternal mortality, MODS,49 SOFA, Chris Hani Baragwanath Hospital"