A retrospective audit of post-caesarean sepsis at Tygerberg Hospital

[摘要] ENGLISH SUMMARY: INTRODUCTION:Caesarean section (CS) is one of the most common surgical procedures performedworldwide and remains the most important individual risk factor for developingpregnancy related sepsis.Pregnancy related sepsis leads to an estimated 75 000 maternal deaths worldwideeach year, with most of these deaths occurring in low and middle-income countries.According to the 2015 Saving Mothers Annual Report, pregnancy related sepsisremained the 3rd leading cause of direct maternal deaths in South Africa.In the USA, the attributable costs (per case) of post CS surgical site infection andpost CS endometritis were estimated around $3500 and $3900 respectively in 2010.AIM & METHOD:To audit post-CS sepsis at Tygerberg Hospital in order to determine the incidence,as well as to describe the risk-factor profile and determine the outcome of womenwho develop post-CS sepsis. A retrospective audit of patient records of all womenwho delivered by CS in a three-month period between 1 February 2014 and 30 April2014 was undertaken. All records were followed up for thirty days after delivery, inorder to identify cases with post-CS sepsis. The CDC diagnostic criteria for surgicalsite infection (both superficial and deep) and endometritis were used.RESULTS:During the 3-month study period a total of 1 834 deliveries were managed atTygerberg Hospital. Eight hundred and forty eight CS were performed, with ahospital-based CS rate of 46.24%. A total of 811 patient records were audited and38 women with post-CS sepsis were identified. The cumulative incidence for post-CSsepsis was therefore 4.69%.Patient characteristics illustrated the high-risk nature of the patient population servedby Tygerberg Hospital, with a high incidence of known risk factors for post-CS sepsissuch as obesity, hypertension and HIV. Risk factors associated with post CS sepsisincluded: HIV infection without antiretroviral therapy (Risk Ratio 5.83, 95% Confidence Interval 1.72 – 19.77, p=0.005) and prolonged surgical duration (RiskRatio 3.01, 95% Confidence Interval 1.10 – 8.19, p=0.03).Thirty-three women had severe post-CS sepsis and were treated as inpatients. Ofthese women, 12 required repeat surgery or admission to a high care or intensivecare unit.CONCLUSION:Despite a post-CS sepsis incidence that compares well with high-income countries(4.69% vs. 3.5 – 8.11%) post-CS sepsis remains a significant contributor to maternalmorbidity in the South African setting. Risk factors for post-CS sepsis remainmultifactorial and in the setting of a referral hospital, all women should be treated aspotentially at risk. Optimization of chronic medical conditions, vigilant intra-partumcare, meticulous surgical technique and recognition of early signs of post-CS sepsisare essential in order to prevent maternal morbidity.

[发布机构] Stellenbosch University