Healthcare system variability and inpatient maternal mortality in the United States.

OBJECTIVE: To examine the association of inpatient maternal mortality with variability in healthcare services delivery such as hospital size, urban/rural designation, teaching/non-teaching status, regional location, and insurance coverage. METHODS: This is a pooled, cross-sectional analysis of the National Inpatient Sample (2012-2014). Information on maternal demographics, clinical conditions, and birth outcomes were identified using respective ICD9-CM codes. Bivariate and multivariate analysis using logistic regression models were used to describe maternal characteristics and to calculate the risk of mortality with each independent variable. RESULTS: The weighted sample included 12,409,939 hospital records (82.6% are 18-34-year-old and 49.5% are Caucasians). Maternal death during hospitalization occurred in 1310 cases (12/100,000 live birth). Women with cardiovascular disorders, hemorrhage or sepsis were 33.6, 4.7, and 5.4 times more likely to suffer inpatient maternal mortality. Compared to small-sized hospitals, delivery at medium or large size hospitals is associated with higher mortality, adjusted odds ratios (aOR) 1.8 (1.4-2.3), and 2.2 (1.8-2.8), respectively. Adjusted OR for inpatient maternal mortality in urban non-teaching or urban teaching compared to rural hospitals were 2.2 (1.7-3.0) and 2.9 (2.2-3.9), respectively. Women in the South have higher maternal mortality compared to Northeast, aOR 1.7 (1.5-2.1). Women coved with public insurance experience higher inpatient maternal mortality compared to those with private insurance, aOR: 2.6 (2.1-3.2) and 1.9 (1.6-2.1), respectively. CONCLUSION: Factors related to variability in healthcare delivery may play a role in inpatient maternal mortality. Some could be explained by the case mix and the clinical conditions affecting birthing outcomes. A qualitative analysis is needed to explore how these factors relate to increased maternal mortality in certain hospital settings.

Causal relationship between gut microbiota and puerperal sepsis: a 2-sample Mendelian randomization study.

Background: Some recent observational studies have shown that gut microbiota composition is associated with puerperal sepsis (PS) and no causal effect have been attributed to this. The aim of this study was to determine a causal association between gut microbiota and PS by using a two-sample Mendelian randomization (MR) analysis. Methods: This study performed MR analysis on the publicly accessible genome-wide association study (GWAS) summary level data in order to explore the causal effects between gut microbiota and PS. Gut microbiota GWAS (n = 18,340) were obtained from the MiBioGen study and GWAS-summary-level data for PS were obtained from the UK Biobank (PS, 3,940 cases; controls, 202,267 cases). Identification of single nucleotide polymorphisms associated with each feature were identified based on a significance threshold of p < 1.0 × 10-5. The inverse variance weighted (IVW) parameter was used as the primary method for MR and it was supplemented by other methods. Additionally, a set of sensitivity analytical methods, including the MR-Egger intercept, Mendelian randomized polymorphism residual and outlier, Cochran's Q and the leave-one-out tests were carried out to assess the robustness of our findings. Results: Our study found 3 species of gut microbiota, Lachnospiraceae FCS020, Lachnospiraceae NK4A136, and Ruminococcaceae NK4A214, to be associated with PS. The IVW method indicated an approximately 19% decreased risk of PS per standard deviation increase with Lachnospiraceae FCS020 (OR = 0.81; 95% CI 0.66-1.00, p = 0.047). A similar trend was also found with Lachnospiraceae NK4A136 (OR = 0.80; 95% CI 0.66-0.97, p = 0.024). However, Ruminococcaceae NK4A214 was positively associated with the risk of PS (OR = 1.33, 95% CI: 1.07-1.67, p = 0.011). Conclusion: This two-sample MR study firstly found suggestive evidence of beneficial and detrimental causal associations of gut microbiota on the risk of PS. This may provide valuable insights into the pathogenesis of microbiota-mediated PS and potential strategies for its prevention and treatment.

Reported self-care practice toward prevention of puerperal sepsis and associated factors among postnatal mothers: Community-based cross-sectional study.

Introduction: Puerperal sepsis is a leading cause of maternal morbidity and mortality in low-income countries, which can affect sustainable development goals. Even though it is a preventable problem through maternal self-care practices, maternal-reported self-care practices regarding puerperal sepsis were under-researched in Ethiopia. Therefore, this study aimed to assess the maternal reported self-care practice and associated factors among postnatal mothers for the prevention of puerperal sepsis. Objective: The study aimed to assess the reported self-care practice of postnatal mothers in Arba Minch town toward the prevention of puerperal sepsis and its associated factors. Methods: A community-based cross-sectional study was employed from 1st to 30th May 2022. Study participants were selected using a simple random sampling technique. Data was collected by the Open Data Kit tool and exported to SPSS version 26 for further analysis. Both crude and adjusted odds ratios with a 95% CI were calculated, and a p-value of less than 0.05 was used to declare statistically significant factors. Results: Of a total of 423 postpartum mothers, 417 participated, making a response rate of 98.5%. The study revealed that 45.6% (95% CI: 41.2%, 50.1%) of postnatal mothers had good reported self-care practices toward the prevention of puerperal sepsis. Tertiary educational level (AOR: 2.56; 95% CI: 1.43, 4.59), multiparity (AOR: 0.44; 95% CI: 0.26, 0.74), and having a good awareness of puerperal sepsis prevention (AOR: 2.17; 95% CI: 1.40, 3.37) were significantly associated at a p-value less than 0.05. Conclusion: This study revealed that less than half of postnatal mothers reported good self-care practices. Healthcare providers and all stakeholders should focus on strategies to improve self-care practice during antenatal and postnatal care and at a community level, with a special focus on postnatal mothers with no formal education and multiparous mothers.

Determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia: an unmatched case-control study.

BACKGROUND: Puerperal sepsis, is a significant factor in maternal morbidity and mortality, especially in regions with lower income levels where maternal mortality rates are highest. However, it can be largely avoided if detected in time. Recognizing and dealing with the root causes early is essential in addressing this problem. Therefore, this study aimed to identify the determinants of puerperal sepsis among postpartum women at a tertiary care hospital in Ethiopia. METHODS: An institutional-based unmatched case-control study was conducted among 266 postpartum women (88 cases and 178 controls) from October 1, 2023 to November 30, 2023. For each case, two controls were chosen using a systematic random sampling approach. Data were collected using an interviewer-administered, structured questionnaire and medical record review. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 27. Binary logistic regression analysis was used to model the association between puerperal sepsis and independent variables. variables that had a crude association in the bivariable analysis (p < 0.25) were entered and analyzed by a multivariable binary logistic regression model to identify statistically significant factors. In the final model, Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. Statistical significance was declared at p < 0.05. RESULT: Rural residence (AOR = 6.9; 95% CI:2.77-17.10), having no formal education (AOR = 3.8; 95% CI: 2.55, 10.76), cesarean section delivery (AOR: 5.1; 95% CI: 1.30, 11.00) and complication during pregnancy (AOR: 4.6, 95% CI: 1.96, 11.10) were independent determinants of puerperal sepsis. CONCLUSION: Place of residence, maternal education level, mode of delivery, and complication during pregnancy were determinants of puerperal sepsis. It is crucial to implement education and awareness initiatives aimed at mothers, ensure universal access to healthcare services, advocate for evidence-based delivery protocols, and conduct comprehensive antenatal screenings.

Prevalence of Maternal Fever and Associated Factors among Postnatal Women at Kawempe National Referral Hospital, Uganda: A Preliminary Study.

Fever is one of the most important signs of infection and can provide useful information for further assessment, diagnosis, and management. Early detection of postnatal fever could reduce severe outcomes, such as maternal mortality due to puerperal sepsis. The purpose of this cross-sectional study was to determine the prevalence of and associated factors of postnatal fever among postnatal women at Kawempe National Referral Hospital. Three hundred postnatal women were recruited. Temperature measurements were conducted and a 29-item questionnaire was completed along with the extraction of health history from the medical records of the participants. The prevalence of maternal fever was 58/300 (19.3%). Multivariable analysis indicated that only four factors-HIV-positive status (AOR = 2.56; 95% CI = 1.02-6.37), labor complications (AOR = 6.53; 95% CI = 2.40-17.71), prolonged labor (AOR = 3.12; 95% CI = 1.11-8.87), and more than 24 h spent in postnatal care (AOR = 5.16; 95% CI = 2.19-12.16)-were found to be significantly associated with postnatal fever. The prevalence of postnatal maternal fever among postnatal women at Kawempe National Referral Hospital was higher than that in other reports in the literature. The factors significantly associated with maternal fever were HIV-positive status, complications during labor, prolonged labor, and more than 24 h spent in postnatal care. Health workers involved in the provision of labor and obstetric services must follow guidelines to assess fever and manage the underlying conditions causing it.

Necrotising fasciitis presenting as a blister: A case report on improving early recognition of surgical site infection following caesarean delivery.

Early recognition and treatment of surgical site infection (SSI) may prevent devastating consequences of wound infections complicating caesarean delivery (CD). SSI complicates 3-15% of CDs; among the severe forms are necrotising fasciitis (NF) and clostridial gas gangrene, with the latter being the most rapidly spreading and fatal. The aim of this report is to improve early recognition of SSI complicating CD. An obese 32-year-old woman, gravida 2 para 1, with a previous uncomplicated vaginal delivery had a CD for fetal compromise in a district hospital. On day 6 after delivery, she presented to the same district hospital with a small blister located on her abdomen above the CD wound. The area around the blister was firm but had no crepitus. The blister was managed expectantly but spread rapidly and had a dusky colour. Both the blister and the surgical site for CD subsequently became foul smelling and the patient was managed in a regional hospital, where she had antibiotic therapy, wound debridement, negative-pressure wound therapy, and secondary wound closure. Healing was complete 69 days after the debridement. The histological report of the wound biopsy confirmed NF. In conclusion, blistering around a surgical site is suggestive of NF. Healthcare professionals managing surgical wounds should have ongoing training on SSI to prevent lack of problem recognition in wound care. All healthcare facilities managing surgical wounds should establish a functional wound care clinic to improve early recognition and treatment of SSI. This entails effective integration of postnatal and CD wound services to improve the care of SSI. Therefore, the algorithm included in this article will be invaluable to care providers.

A rare and fatal case of tubo-ovarian abscess due to Burkholderia pseudomallei presenting as puerperal sepsis.

Introduction: Melioidosis is an emerging life-threatening infectious disease caused by the Gram-negative Burkholderia pseudomallei found in contaminated soil and surface ground water. It often presents with varied clinical manifestations and has a high mortality if left untreated due to lack of clinical suspicion. Here we report a rare and fatal case of tubo-ovarian abscess presenting as puerperal sepsis due to B. pseudomallei in a young woman. Case report: A 25-year-old female presented for medical consultation at day 43 postpartum complaining of fever on and off for the past 40 days associated with vomiting. On per speculum examination, greenish discharge from the cervix was seen and a right adnexal mass was felt which was cystic in consistency, non-tender and pushing the cervix to the left side. An exploratory laparotomy was carried out and pus was drained from below the rectus sheath, and from the right tubo-ovarian mass. Peripheral blood and the pus samples collected intraoperatively grew B. pseudomallei . The patient died on the fifth post-operative day due to septic shock with disseminated intravascular coagulation secondary to puerperal sepsis. Conclusion: Melioidosis is a fatal but treatable disease when it is promptly diagnosed. In countries such as India, where tuberculosis is highly endemic, underdiagnosis of melioidosis can be common. Clinicians and microbiologists should have a high index of suspicion of melioidosis especially in individuals with underlying illness.

Modified Early Obstetric Warning Criteria Predict Maternal Morbidity in the Immediate Postpartum Period: A Case-Control Study.

OBJECTIVE: To evaluate the application of Modified Early Obstetric Warning Criteria (MEOWC) in the immediate postpartum period and to generate a preliminary predictive model for postpartum maternal morbidity. DESIGN: Retrospective case-control study that was conducted from January 2017 to January 2020. A total of 2,762 births occurred during the study period. SETTING: Obstetrics unit of a general hospital located in the Nakhon Si Thammarat province of Thailand. PARTICIPANTS: Three hundred charts of complete health records for women in the first 24 hours postbirth were used in the study. Severe maternal morbidity indicators from the Centers for Disease Control and Prevention as well as corresponding International Classification of Diseases, 10th Revision-Clinical Modification codes during birth and postpartum hospitalizations were used to define maternal morbidity. Case and control individuals were matched in an approximate 1:2 fashion based on the year when the birth occurred. MEASUREMENTS: Outcomes measurement was carried out using three data record forms-personal data, obstetric history, and MEOWC. To estimate the risks, logistic regression was performed, and a receiver operating characteristic curve was derived to evaluate the model's performance. RESULTS: One hundred cases of maternal morbidity that occurred in the immediate postpartum period were identified and matched with 200 control cases. Women with MEOWC during the immediate postpartum were much more likely to experience subsequent postpartum maternal morbidity than were women without the criteria. MEOWC were a moderate predictor of postpartum maternal morbidity. CONCLUSION: MEOWC are associated with increased odds of postpartum maternal morbidity. However, these findings should be validated in a prospective cohort to develop a predictive model that is effective for use in immediate postpartum care.

Determinants of puerperal sepsis among post-partum mothers in Mekelle city public hospitals, Tigray, Ethiopia, 2021: a case control study.

BACKGROUND: Puerperal sepsis is among the leading causes of preventable maternal death not only in developing countries but also in developed countries which is usually reported as the third or fourth common direct cause of maternal death. Although the prevalence of puerperal sepsis is low, it is the significant cause of maternal mortality, morbidities and other long-term complications like secondary infertility. The aim of this study was to assess the determinants of puerperal sepsis among post-partum mothers at Mekelle city public hospitals. METHOD: Institution based unmatched case control study was conducted among 444 total sample size (111 cases and 333 controls) in Mekelle city public hospitals from March 21, 2021 to April 20, 2021. Consecutive sampling for the cases and systematic sampling for the controls was used. Pretested structured questionnaire was used to collect data and the data was entered into Epi data version 4.1 then cleaned, coded and edited and exported to SPSS version 23 statistical software for analysis. Logistic regression was done and variables with a P-value of < 0.25 on Binary logistic regression were taken to multiple logistic regression analysis. At 95% confidence interval, a P-value of < 0.05 was used as cut-off point to declare the association with the dependent variable. RESULTS: Multiple logistic regression analysis revealed that rural residence (AOR: 3, 95% CI: 1.50-5.90), no ANC follow up (AOR: 2.7, 95% CI: 1.08-6.71), duration of rupture of membrane > 24 h (AOR: 4.1, 95% CI: 1.60-10.58), duration of labor > 24 h (AOR: 4.3, 95% CI: 1.86-9.92), number of vaginal examination > = 5 (AOR: 2.8, 95% CI: 1.26-6.26), cesarean section mode of delivery (AOR: 2.8, 95% CI: 1.48-5.20) and no PNC follow up (AOR: 3.9, 95% CI: 1.60-9.36) were the determinant factors of puerperal sepsis in this study. CONCLUSION: The determinants of puerperal sepsis in this study were rural residence, not having antenatal care, prolonged duration of rupture of membrane, prolonged duration of labor, frequent number of vaginal examination, cesarean section and not having postnatal care. It is recommended that strengthening provision of health education on danger signs of pregnancy, parthograph utilization and avoiding of frequent vaginal examinations.

Tubo-ovarian abscess after vaginal delivery: A case report and review of current literature.

Tubo-ovarian abscesses in pregnancy and the post-partum period are extremely rare. We report a case of a 31-year-old woman who presented with an acute abdomen and sepsis in the post-partum period with a background of a large endometrioma diagnosed prior to conception. Exploratory laparoscopy revealed a ruptured tubo-ovarian abscess which was surgically drained and then treated with intravenous antibiotics. This report is seemingly unique in presenting the development of antenatal endometrioma into a tubo-ovarian abscess and an unusual differential for abdominal pain to consider in the immediate postpartum period.

Determinants of term premature rupture of membrane: case-control study in Saint Paul's Millennium Medical College Hospital, Addis Ababa, Ethiopia.

BACKGROUND: The term premature rupture of the membranes is the rupture of the membranes before the onset of labor beyond 37 weeks of gestation. Several factors, including obstetric, gynecologic, socioeconomic, and medical, are identified as potential risk factors. This clinical event has detrimental maternal and neonatal complications. OBJECTIVES: This study aimed to investigate the determinants of the term premature rupture of the membranes in Ethiopia. METHODS: This institution-based unmatched case-control study was conducted on 246 women admitted to Saint Paul's hospital millennium medical college from October 2019 to January 2020 (82 cases and 164 controls). Data were collected using an interviewer-based questionnaire and data extraction tools, and data were entered using Epi data 3.1 and analyzed using SPSS 20. The association between independent variables and premature rupture of the membrane was estimated using an odds ratio with 95% confidence intervals and P-value < 0.05. RESULTS: Factors like a history of vaginal discharge (AOR 3.508;95% CI:1.595.7.716), place of Antenatal care follow-up (health center and Mercy Ethiopia) (AOR 5.174;95% CI:2.165,12.362), the previous history of rupture of membrane (AOR 9.955;95% CI:3.265,20.35), and gestational age (AOR 3.018;95% CI:1.338,6.811) were associated with term premature rupture of membrane. There were more maternal and neonatal complications, including puerperal sepsis, wound infection, anemia/PPH, a hospital stays of more than seven days, clinical amnionitis, neonatal hypoglycemia, early onset neonatal sepsis, and respiratory distress encountered by women who presented with premature rupture of membrane. CONCLUSION: Proper screening, close monitoring, and early interventions in those mothers with identified risk factors would help to reduce its negative consequences. Moreover, the provision of continuous professional skill development and improving the quality of ANC service is needed.

Laparoscopic approach in postpartum pyoperitoneum: A guide to early rehabilitation.

Sepsis is a leading cause of maternal mortality and morbidity worldwide. Pyoperitoneum is a grave and life-threatening manifestation of puerperal sepsis. Administration of broad-spectrum antibiotics and drainage of pus by laparotomy has long been the cornerstone of treatment for pyoperitoneum in a parturient. In this series of six cases, the successful laparoscopic management of postpartum pyoperitoneum is discussed. The latter offers the advantage of a magnified view of the surgical field, thorough lavage and drainage, and avoidance of long incisions to explore the abdomen, resulting in faster recovery, less pain, greater patient satisfaction, and lower economic burden.

Comparison lecture and concept map methods on the level of learning and satisfaction in puerperal sepsis education of midwifery students: a quasi-experimental study.

BACKGROUND: Education and training about emergency cases are necessary for different medical groups such as midwives. Teaching puerperal sepsis is important for midwives. The teaching method is one of the challenges of the educational system in universities. This study was conducted to compare lecture and concept map methods on the level of learning and satisfaction in puerperal sepsis education of midwifery students. METHOD: This semi-experimental study was conducted in 2022 at Ardabil Nursing and Midwifery School on 50 midwifery students. Students randomly were placed in lecture and concept map teaching groups. To collect data, a 23-question satisfaction questionnaire and a 15-question test taken from the WHO books on the management of puerperal sepsis were used to check students' knowledge and learning. The data were analyzed by using descriptive statistics and independent and paired t-test SPSS software. FINDINGS: The average learning score of the students after teaching in the concept map group was 10.28 ± 1.90 and the lecture group 9.20 ± 1.70, the difference was statistically significant (p = 0.04). The average satisfaction score in the concept map group was 107.92 ± 4.46 and in the lecture group 105.68 ± 6.84, this difference was statistically significant (p = 0.03). CONCLUSION: The teaching of puerperal sepsis with the concept map method had a greater effect on the learning and satisfaction of midwifery students. Therefore, it is recommended to use this educational method.

Determinants of puerperal sepsis among postpartum women at public hospitals of Hawassa city, Southern Ethiopia: Institution-based unmatched case-control study.

Background: World health organization reported that from 358,000 maternal deaths occurring during labor and childbirth about 15% were attributed to puerperal sepsis. In Ethiopia, puerperal sepsis is the fourth leading direct cause of maternal death next to hemorrhage, obstructed labor, and pregnancy-induced hypertension. Early recognition and management of the contributing factors would help to modify the problem. Therefore, this study was aimed to identify the determinants of puerperal sepsis among postpartum women at Hawassa city public hospitals in South Ethiopia. Methods: & materials: Institution-based unmatched case-control study was conducted among 305 postpartum women (61 cases & 242 controls; with a ratio of 1:4) at Hawassa city public hospitals from June 17 to August 20/2021. Cases were all postpartum women admitted with puerperal sepsis and controls were randomly selected postpartum women admitted with other cases. A pre-tested interviewer-administered questionnaire was used to collect the data. Data were entered into Epi data version 4.6 and then exported to STATA version 14 for analysis. Bivariable analysis was performed and variables having a p-value <0.25 made candidates for the multivariable logistic regression model. Adjusted Odds ratio (AOR) with 95% confidence interval was computed to identify the presence and strength of association and statistical significance was declared at p-value <0.05. Result: In this study, a total of 61 cases & 242 controls were included. Cesarean section delivery (AOR = 2.85; 95% CI; 1.36-5.98), manual removal of placenta (AOR = 6.0; 95% CI = ; 0.39-26.26), ≥5 times Per-vaginal Examination during labor (AOR = 4.53; 95% CI; 2.10-9.80), presence Gestational Diabetes Mellitus (AOR = 8.50; 95% CI; 1.99-36.33) & prolonged labor (AOR = 3.43; 95% CI; 1.20-9.76) were identified as determinants of puerperal sepsis. Conclusion: In this study, cesarean delivery, Per-vaginal Examination ≥5 times during labor, manual removal of placenta, Gestational Diabetes Mellitus & prolonged labor were factors that significantly increased the odds of developing puerperal sepsis among postpartum women. So, labor & delivery procedures should be conducted as per labor & delivery management protocols.

Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study.

Background: Puerperal sepsis is one of the leading causes of maternal mortality, particularly in low and middle-income countries where most maternal deaths occur. Women with puerperal sepsis are prone to long-term disabilities, such as chronic pelvic pain, blocked fallopian tubes, and secondary infertility. Besides this, puerperal sepsis has received less attention. For this reason, this study aimed to determine the incidence of puerperal sepsis and its predictors among postpartum women at Debre Markos Comprehensive Specialized Hospital. Methods: A prospective cohort study was conducted among 330 postpartum women from September 2020 to 2021. A pre-tested interviewer-administered questionnaire with a data extraction checklist was used to collect the data. Data were entered into Epi data 4.2 and analyzed using STATA 14.0. The incidence rate of puerperal sepsis was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probability of developing puerperal sepsis. The cox-proportional hazards regression model was fitted to identify predictors of puerperal sepsis. Results: The study participants were followed for a total of 1685.3 person-week observations. The incidence rate of puerperal sepsis was 14.24 per 1,000 person-weeks. However, the overall incidence of puerperal sepsis was 7.27%. Not attending formal education [AHR: 3.55, 95% CI: (1.09-11.58)], a cesarean delivery [AHR: 4.50; 95% CI: (1.79-11.30)], premature rupture of the membranes [AHR: 3.25; 95% CI: (1.08-9.79)], complicated pregnancy [AHR: 4.80; 95% CI: (1.85-12.43)], being referred [AHR: 2.90; 95% CI: (1.10-7.65)], and not having birth preparedness and complication readiness plan [AHR: 2.95; 95% CI: (1.08-10.50)] were statistically significant predictors of puerperal sepsis. Conclusion: The incidence of puerperal sepsis was 7.27%. Not attending formal education, cesarean delivery, premature rupture of membranes, complicated pregnancy, referral status, and absence of birth preparedness and complication readiness plan were predictors associated with the incidence of puerperal sepsis.

Post-partum Thrombotic Thrombocytopenic Purpura with Puerperal Sepsis- A Case Report.

Introduction: Post-partum TTP is an uncommon thrombotic microangiopathy affecting about 1 in 200,000 pregnancies in contrast to preeclampsia and HUS, which have been reported commonly. Case presentation: We report a case of a postpartum TTP following purpureal sepsis. The patient was brought with per vaginal bleed, vomiting, chest pain, yellow discoloration of sclera, and abdominal discomfort following a spontaneous vaginal delivery two days back at a hospital. Clinical findings and investigations: The workup revealed anemia and thrombocytopenia with deranged PT/INR. The renal profile deteriorated over one day and she also developed psychosis. Additionally, schistocytes were observed on the peripheral blood smear. Interventions and outcome: The patient was subsequently treated with dialysis followed by plasmapheresis in addition to the antibiotics after the diagnosis of TTP and made a complete recovery. Relevance and impact: 25% of TTP occurs in the intra or postpartum period. It is thus pivotal to keep it among differentials and intervened timely to reduce morbidity and mortality. Vigilance is required to prevent any relapse in subsequent pregnancies.

Study of cases of puerperal sepsis, its socio-demographic factors, bacterial isolates, and antibiotic sensitivity pattern.

Objective: Due to the lack of resources for culture and antibiotic susceptibility testing in most underdeveloped countries, puerperal sepsis is treated empirically with a wide range of antibiotics. Empirical treatment, on the other hand, does not ensure treatment effectiveness and may even contribute to antibiotic resistance. So, we studied cases of puerperal sepsis, its socio-demographic factors, bacterial isolates, and antibiotic sensitivity in a tertiary health center. Material and Methods: This was a cross-sectional study conducted at the obstetrics and gynecology department of a tertiary health center in India from April 2019 to September 2020. During this time, all patients with sepsis who met the criteria for inclusion were included. After granting an informed written consent, the subjects were registered on a pre-designed proforma. Results: There were 2,049 obstetrical admissions throughout this period, with 106 (5.1%) of these having puerperal sepsis. The majority of these women (58.7%) were between the ages of 21 and 30, were multiparous (96.5%), and unbooked. Fever 104 (98.1%) was the most prevalent clinical characteristic, whereas wound gape was the most common consequence (47.1%). Klebsiella aerogens was the most common organism found in various cultures. Many organisms were shown to be multidrug-resistant and sensitive to gentamycin and amikacin. Conclusion: Klebsiella aerogens wasthe most common cause of puerperal sepsis in this investigation. Because the causal agents of puerperal sepsis and their antibiotic sensitivity patterns change over time, positive blood culture and antibiotic susceptibility of the isolates are the best guides for selecting the optimum antimicrobial therapy for treating sepsis.

Incidence and determinants of maternal sepsis in Ghana in the midst of a pandemic.

BACKGROUND: Despite being preventable, maternal sepsis continues to be a significant cause of death and morbidity, killing one in every four pregnant women globally. In Ghana, clinicians have observed that maternal sepsis is increasingly becoming a major contributor to maternal mortality. The lack of a consensus definition for maternal sepsis before 2017 created a gap in determining global and country-specific burden of maternal sepsis and its risk factors. This study determined the incidence and risk factors of clinically proven maternal sepsis in Ghana. METHODS: We conducted a prospective cohort study among 1476 randomly selected pregnant women in six health facilities in Ghana, from January to September 2020. Data were collected using primary data collection tools and reviewing the client's charts. We estimated the incidence rate of maternal sepsis per 1,000 pregnant women per person-week. Poisson regression model and the cox-proportional hazard regression model estimators were used to assess risk factors associated with the incidence of maternal sepsis at a 5% significance level. RESULTS: The overall incidence rate of maternal sepsis was 1.52 [95% CI: 1.20-1.96] per 1000 person-weeks. The majority of the participants entered the study at 10-13 weeks of gestation. The study participants' median body mass index score was 26.4 kgm-2 [22.9-30.1 kgm-2]. The risk of maternal sepsis was 4 times higher among women who developed urinary tract infection after delivery compared to those who did not (aHR: 4.38, 95% CI: 1.58-12.18, p < 0.05). Among those who developed caesarean section wound infection after delivery, the risk of maternal sepsis was 3 times higher compared to their counterparts (aHR: 3.77, 95% CI: 0.92-15.54, p < 0.05). Among pregnant women who showed any symptoms 14 days prior to exit from the study, the risk was significantly higher among pregnant women with a single symptom (aHR: 6.1, 95% CI: 2.42-15.21, p < 0.001) and those with two or more symptoms (aHR: 17.0, 95% CI: 4.19-69.00, p < 0.001). CONCLUSIONS: Our findings show a low incidence of maternal sepsis in Ghana compared to most Low and Middle-Income Countries. Nonetheless, Maternal sepsis remains an important contributor to the overall maternal mortality burden. It is essential clinicians pay more attention to ensure early and prompt diagnosis. Factors significantly predicting maternal sepsis in Ghana were additional maternal morbidity, urinary tract infections, dysuria, and multiple symptoms. We recommend that Ghana Health Service should institute a surveillance system for maternal sepsis as a monthly reportable disease.

Case report: An unusual presentation of puerperal sepsis.

Group A Streptococcus (GAS; Streptococcus pyogenes) is a facultative gram-positive coccus, uncommonly colonizing parturient genitalia, where its presence can potentially lead to a life-threatening invasive infection after delivery. GAS infection typically occurs within the first 4 days post-partum and is characterized by high fever, chills, flashing, abdominal pain, and uterine tenderness. Nonetheless, patients with GAS puerperal sepsis may have an unusual presentation, when fever is absent, and the symptoms and signs can be mild, non-specific, and not indicative of the severity of infection. This unusual presentation may lead to a delayed diagnosis and increase the risk for severe puerperal sepsis. Therefore, in these cases, a high index of suspicion and prompt early antibiotic and surgical treatment is crucial to saving the parturient's life.

Exploring terminology for puerperal sepsis and its symptoms in urban Karachi, Pakistan to improve communication, care-seeking, and illness recognition.

Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. Awareness of local terminology for its signs and symptoms may improve communication about this illness, what actions to take when symptoms appear, timely care seeking, and clinical outcomes. This formative research aimed to improve recognition and management of postpartum sepsis in Pakistan by eliciting local terms used for postpartum illnesses and symptoms. We conducted 32 in-depth interviews with recently delivered women, their relatives, traditional birth attendants, and health care providers to explore postpartum experiences. Terms for symptoms and illness are used interchangeably (i.e. bukhar, the Urdu word for fever), many variations exist for the same term, and gradations of severity for each term as not associated with different types of illnesses. The lack of a designated term for postpartum sepsis in Urdu delays care-seeking and proper diagnosis, particularly at the community level. Ideally, a common lexicon for symptoms and postpartum sepsis would be developed but this may not be feasible or appropriate given the nature of the Urdu language and local understandings of postpartum illness. These insights can inform how we approach educational campaigns, the development of clinical algorithms that focus on symptoms, and counselling protocols.