RISK FACTORS AND CLINICAL OUTCOMES OF PUERPERAL SEPSIS: A RETROSPECTIVE STUDY FROM A TERTIARY CARE HOSPITAL IN DERA ISMAIL KHAN

Abstract

Background: Puerperal sepsis is a significant contributor to maternal morbidity and mortality, especially in low and middle-income countries where delayed diagnosis, obstetric complications and limited access to timely treatment exacerbates severe maternal outcomes. To optimize maternal care, it is crucial to identify clinical and obstetric risks of poor outcomes. Objective: The aims of this study were to evaluate the maternal, obstetric, healthcare-related, clinical and microbiological risk factors that are associated with adverse maternal outcomes among women with puerperal sepsis and to determine independent factors for adverse maternal outcomes. Methods: A retrospective cohort study was carried out in 250 women with puerperal sepsis admitted at the Department of Obstetrics and Gynecology, Women and Children Hospital, Dera Ismail Khan, KP, Pakistan. Demographic features, obstetric history, health care components, clinical features, laboratory parameters, microbiological profiles and maternal parameters were analysed. Descriptive statistics, univariable logistic regression and multivariable logistic regression were done. Adverse maternal outcomes were assessed for independent predictors after adjusting for other risk factors, using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: Of 250 women, 88 (35.2%) had adverse maternal outcomes. Extended hospitalisation (32.8%), admission to intensive care unit (16.4%) and septic shock (13.6%) were the most common complications. Culture positivity was noted in 56.8% of cases with the main organisms being Escherichia coli (33.8%) and Klebsiella species (21.1%). Hypotension at presentation was found to be the strongest predictor of adverse outcomes using the multivariable analysis (AOR=6.39; 95% CI=2.57-15.89; p<0.001). Other significant predictors included retained products of conception (AOR=4.58; 95% CI: 1.81–11.61; p=0.001), postpartum haemorrhage (AOR=3.21; 95% CI: 1.45–7.13; p=0.004), prolonged labour >12 hours (AOR=2.83; 95% CI: 1.37–5.86; p=0.005), prolonged rupture of membranes >18 hours (AOR=2.60; 95% CI: 1.33–5.10; p=0.005), CRP >120 mg/L (AOR=2.53; 95% CI: 1.22–5.22; p=0.012), and caesarean delivery (AOR=2.24; 95% CI: 1.20–4.17; p=0.011). Conclusion: The maternal morbidity associated with puerperal sepsis was significant, and adverse outcomes were primarily related to haemodynamic instability, obstetric complications and indicators of severe infection. To minimize severe maternal outcomes, it is crucial that high-risk patients are identified early, that appropriate antimicrobial therapy is promptly started, and obstetric care is delivered effectively.