THE PREDISPOSING FACTORS AND THE MICROORGANISMS ISOLATED FROM PATIENTS WITH PUERPERAL SEPSIS IN IKEJA, NIGERIA

Abstract

BACKGROUND: Puerperal sepsis is one of the leading causes of
preventable maternal morbidity and mortality in developing nations.
However, the predisposing factors and the isolated organisms from the
endo-cervix of patients with puerperal sepsis vary considerably from one
region to another. This variation affects the prevention and treatment of
cases. Hence, the need to know what obtains in our environment.
OBJECTIVE: This study was designed to determine the incidence of and the
predisposing factors to puerperal sepsis in patients seen at LASUTH, Ikeja as
well as to describe the isolated microorganisms and their antibiotic
sensitivity pattern.
METHODOLOGY: This was a cross-sectional study in which consecutive
patients seen at the hospital with puerperal sepsis were counseled and
their informed consent obtained before being recruited into the study. The
recruitment lasted a period of 8 months. A proforma was used to obtain
socio-demographic data and information relating to puerperal sepsis at
presentation. These data were compared with data from women without
puerperal sepsis within the same period of study in order to determine the
predisposing factors to puerperal sepsis. Endo-cervical swabs were taken
from all patients with puerperal sepsis and sent to the laboratory for
isolation of microorganisms and antibiotic susceptibility test. The data
obtained were entered into and analyzed using Statistical Package for Social
Sciences (SPSS), version 20.0; a statistical computer program.
RESULTS: The frequency of puerperal sepsis in LASUTH was determined to
be 3.59%. Majority of the patients were of low socioeconomic class (70.8%)
and 62.5% of the patients were not booked in LASUTH .The predisposing
factors identified were Caesarean section, unbooked status, delivery
outside LASUTH and primiparity with Odd Ratios of 4.94, 4.18, 3.68 and
1.62, respectively.
The commonest microorganisms isolated were Staphylococcus aureus
(28.1%) and Escherichia Coli (17.6%). Overall, the isolated microorganisms
had high sensitivity to Co-amoxiclav (82%) and Levofloxacin (78.8%).
Eight (8) out of the 96 patients with puerperal sepsis died, giving a case
fatality rate of 8.3%. Puerperal sepsis was the second commonest cause of
maternal deaths in LASUTH, accounting for 24.2% of maternal mortality
over the period of study.
CONCLUSION: The findings suggest that the predisposing factors to
puerperal sepsis were Caesarean section, unbooked status, delivery outside
LASUTH and primiparity. Staphylococcus aureus and Escherichia coli are the
commonest isolated organisms and they are highly sensitive to Co
amoxiclav and Levofloxacin.
Puerperal sepsis still presents a significant risk of maternal mortality

THE PREDISPOSING FACTORS AND THE MICROORGANISMS ISOLATED FROM PATIENTS WITH PUERPERAL SEPSIS IN IKEJA, NIGERIA