Severe Maternal Morbidity and Mortality Due To Postpartum Infection In Rwanda

Abstract

Abstract: Objective: The objective of this study is to evaluate ‘near miss’ and mortality in women with postpartum infections. Methods: We performed a retrospective review of all patients referred to the University Teaching Hospital of Kigali (CHUK) between January 2012 and December 2013. We identified 117 patients with postpartum infections. Demographic data, length of admission, location of referral, initial surgery and subsequent treatment modalities including antibiotic administration and secondary surgery were recorded. The primary outcome of interest was a composite of maternal mortality and “near miss” defined as more than one laparotomy with/without hysterectomy and prolonged hospitalization. Results: All patients were transferred from district hospitals. Diagnoses at CHUK were: pelvic peritonitis (57%), deep surgical site infection including fasciitis (17%), and Endometritis (15%). The primary procedures performed prior to transfer were: cesarean section (79 %), septic abortion management (14%), and vaginal delivery (6%). Antibiotics were initiated prior to transfer in 66% of women. Surgery was required in 73% of patients. Hysterectomies were performed in 22% of patients. Maternal death occurred in 4% of the patient population. Conclusion: Peritonitis—primarily as a result of cesarean deliveries—is associated with significant morbidity and mortality in our population. Keywords: Rwanda; peritonitis; near miss; severe maternal morbidity; maternal mortality Denis