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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cases of maternal deaths at Wesley Guild Hospital, Ilesa, Nigeria, from January 1977 to June 1988 were reviewed. The maternal mortality rate of 2.85 per 1000 births recorded is an improvement over earlier figures due at least in part to improved obstetric care services. Illegally induced abortion was the most significant cause of maternal deaths (32.7%). Other causes were sepsis (17.3%), obstetric haemorrhage (15.4%), ruptured uterus (9.6%) and anaemia (7.7%). The problems of illegal abortion, poor antenatal and delivery supervision and late referral of cases were implicated as aetiologic factors.
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PMID:Trends in maternal deaths in Ilesa, Nigeria, 1977-1988. 206 88

Septic shock in obstetrics is a major cause of mortality. Postpartum endometritis is often the first step of bacterial colonization inside the uterus which becomes the nidus of infection. Rapid spread into general circulation is favoured by hemodynamics patterns of pregnancy. Bacteremia would result in cardiovascular collapse and a myocardial depressant factor has been proposed to explain the fall in cardiac output. Later, endotoxin activates the substances of malignant intravascular inflammation and multiple systems organ failure may be observed in uncontrolled sepsis. Eight cases are reported hospitalized at Morelia's General Hospital, SSA, with septic shock and MSOF. Presumably because of aggressive acute resuscitation nobody succumbed during acute cardiac failure and hypotensive episode but two patients died later with multiple system organ failure. The mortality was 25%. Fluid, resuscitation, and vasoactive drugs are the most effective way to reduce mortality. Antibiotics, specific treatment of MSOF and taking away the nidus of infection are critical components of therapy.
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PMID:[Septic shock in obstetrics]. 207 37

case of fatal septic shock due to pyomyoma (suppurative leiomyoma of the uterus) is reported. This unusual cause of sepsis and polymicrobial bacteremia should be rapidly identified because surgical therapy is essential for cure. Nine additional cases reported since 1945 are reviewed. Pyomyoma develops in association with either recent pregnancy or in postmenopausal patients who frequently have underlying vascular disease. The triad of: 1) bacteremia or sepsis; 2) leiomyoma uteri; and 3) no other apparent source of infection should suggest the diagnosis of pyomyoma.
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PMID:Pyomyoma associated with polymicrobial bacteremia and fatal septic shock: case report and review of the literature. 220 49

Medical records of 194 patients with ruptured uteri at Mulanje CCAP Hospital in Malawi were studied from January 1974 to December 1982. The mortality rate was 10.3%; this figure was elevated with rupture of an intact uterus, primigravidity, rupture prior to hospital admissions, and being in shock when admitted. Fetal mortality was 70% and strongly correlated with maternal mortality. A stronger relationship was found between fetal mortality and shock, absence of scar, and time of rupture. Fetal mortality was also associated with surgery performed, completeness of rupture, and rupture diagnosis prior to delivery. Hysterectomies were performed in 33.3% of the cases. 3 groups were identified among the cases: unscarred uterus ruptured before admission, scarred uterus ruptured prior to admission, and scarred uterus ruptured in hospital. For the 1st group, factors contributing to the uterus rupture include cephalopelvic disproportion, malpresentation, prolonged labor, and herbal oxytocies. In this group, 57% were para 5. The majority of women in the other 2 groups were para 1-4. Incidences of shock varied between the 3 groups; the unscarred group had 67% with shock while the scarred ruptures had 38% (prior to admissions) and 8% (after hospital admission). An anterior rupture site was the most common site of uterus rupture; the findings are 49% for the 1st group, 81% for the 2nd group, and 90% for the 3rd group. The highest mortality rate (20%) was observed in women with unscarred uterus rupture before admission. Fetal mortality was 95%, 57%, and 27% for the 3 groups respectively. The major causes of death were shock and sepsis. Prolonged hospital stay was attributed to wound infection or vesico-vaginal fistula.
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PMID:Ruptured uterus in Mulanje CCAP Hospital, 1974-1982. 228 75

To study cases of ruptured gravid uterus in Ile-Ife, Nigeria, medical records were examined. From January 1979 to December 1986, the records indicated 30,511 deliveries and 120 cases of ruptured uterus; the incidence rate was 0.4%. 112 patient records were studied. Findings included a mean patient age of 28.5 for 4.0 years, parity of 3-4 children (42%), 74% unbooked cases, and 29 booked cases. 41% of the booked cases had previous cesarean sections. 88% of the patients' labor started at home. Spontaneous uterine rupture occurred in 75% of the cases; 58% had complications of feto-pelvic disproportion and grand multiparity (30%). 15% of booked and unbooked patients had previous cesarean sections. Additional findings include iatrogenic rupture in 10% of the cases, involvement of lower uterine segment in 82%, lacerated urinary bladder (14%). Surgical procedures employed included uterine repair (50%), subtotal hysterectomy (25%), and total hysterectomy (24%). Patients receiving total hysterectomy had a mortality rate of 4% compared to 21% of all other groups. The most common maternal complications included maternal death (17%), prolonged hospital stay (58%), wound sepsis (32%), genital tract sepsis (26%), and septicemia (10%). The primary causes of death were septicemia and hemorrhagic shock. Booked patients had low mortality rates (10%) compared to unbooked patients (19%). The perinatal mortality rate was 94%. It is suggested that adequate, affordable antenatal and delivery care could decrease the complications involved with uterine rupture.
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PMID:Rupture of the gravid uterus in Ile-Ife, Nigeria. 228 84

This paper examines the nature of abdominal deliveries in 100 women who presented at the Holy Family Hospital in Ghana, suffering from delivery complications. The main indicator disease for surgery was cephalic- pelvic distortion, previous cesarian section, ruptured uterus, and placenta previa with hemorrhage. The most common septic complication of abdominal deliveries is purulent wound infections. 4 deaths occurred, within 48 hours of surgery, and none of the survivors developed pelvic abscess. Sepsis is the most important factor in maternal morbidity and mortality; risk factors associated with delivery of C-section include inadequate antenatal care, anemia, poor socioeconomic status, prolonged labor with ruptured membranes. However this information must be weighed in the context of the existing environment. Most of the cases present to the hospital in severe distress, having been in labor for many hours. Therefore, it is important to provide comprehensive education through primary health care to traditional birth attendants on issues surrounding pregnancies. For the purpose of prevention of sepsis, prophylactic antibiotics should be used on mothers showing evidence of complications, and more importantly, they should be aggressively administered to those women having ruptured membranes.
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PMID:Septic complications of 100 abdominal deliveries in the rural tropics. 230 84

This study describes institutional maternal mortality (MM) in the Thika subdistrict of Nairobi, Kenya, and also identifies socio-demographic and gynecological factors that have a bearing on MM. This study was retrospective from January 1981-January 1985 and prospective thereafter to September 1988. It was based on maternal death case reports from 3 main institutions offering maternity delivery services. The case reports were studied for maternal complications in pregnancy, labor and puerperium, for age, parity, fate of fetus, antenatal record, primary and secondary causes of mortality. Gynecological cases of death such as abortions, ectopic pregnancies, and trophoblastic disease were also considered. There were 164 MM and 86,248 live births. Results indicated that: 1) maternal age of 15-19 years does not appear to be at increased risk because of the numbers of those 19; 2) the risk is greater for primipara's and grandmultipara's. Marital status, education, and occupation did not influence MM; 3) more than 63% of MM occurred in the 1st week of admission; only 2.1% of these mothers had attended antenatal clinic, they started late in their pregnancy and the antenatal care received was inadequate; 4) the diagnosis as to causes of death for most of the cases was clinical; 5) sepsis of any association was a factor and was found to be very high in the post-operative MM with the triad of hemorrhage, ruptured uterus and hypertensive disease prominent. 6) Of the 164 MM, 9.8% were avoidable in the hospitals with their facilities; 51.2% were avoidable in hospital with improved facilities; 29.2% were avoidable elsewhere and only 9.8% were totally unavoidable.
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PMID:Socio-demographic and gynaecological variables of maternal mortality in a Kenyan subdistrict: January 1981-September 1988. 236 45

The intra-aortic++ introduction of a complex of drugs was performed to 34 patients with sepsis of obstetric-gynecological etiology. The disease appeared in 23 patients after extrahospital abortions, in 7 patients after delivery, in 4 patients after operation of cesarean section. Septic pneumonia took place in 23 patients. Antiseptic treatment was also used in all the patients. Recovery was noted in 32 of 34 patients, 23 of them were discharged from the hospital without removal of the uterus. Conclusion may be made that the intra-aortic++ administration of drugs is a highly effective method of treatment of obstetric-gynecological sepsis.
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PMID:[Non-surgical sanitation in patients with obstetrical and gynecological infections]. 259 22

Obstetrical sepsis is one of the most important causes of maternal mortality. An obligatory procedure in the management of sepsis is liquidation of the infection focus. For this purpose drainage and irrigation of the uterine cavity with Baliz-2, an antiseptic solution, were included in the complex of therapeutic measures for 49 patients with the purulent focus in the uterus. The focus was liquidated in all the cases, no complications were recorded. This recommends such procedure for the treatment of patients with obstetrical sepsis.
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PMID:[Treatment of obstetrical infection]. 261 58

2 studies have been done in China: 1) a longitudinal study on maternal mortality in Beijing from 1949 to 1983; and 2) a cross-sectional study on maternal mortality in the year 1984 in 21 of 29 provinces, municipalities, and autonomous regions. A maternal and child health network for care and referral of abnormal cases was set up with ambulances and transfusion facilities in place and training for traditional birth attendants. Aseptic delivery reduced the number of deaths due to sepsis from 213/100,000 live births to 4.2 in 5 years and to 0 in 9 years. Deaths from hemorrhage (including ruptured uterus) dropped by 86% in 5 years. With legalized abortion came a dramatic fall in maternal mortality from 685,100/000 live births to 15, a decrease of 98%. In 1949, 27% of women who died in childbirth had received hospital care; another 27% had no cure. In 1958, however, 80% of the fetal cases had obtained hospital care; the remaining 20% had been seen by a traditional practitioner or health worker. From 1959-68, the total maternal mortality was 1.3-28.1/1 00,000. From 69-78, the turmoil of the cultural revolution had "ill effects" on maternal and child health but by 1979, order was brought back again. The cross-sectional study covered a population of about 177 million. About 2.5 million live births occurred. 1211 maternal deaths were registered for a maternal mortality rate of 48.4/100,000. Maternal mortality varied a good deal in different parts of the country--from 17.7 in Shanghai to 108.2 in the region of the Hai people in Ningxia in northwest China. Maternal mortality rates correspond roughly to the level of economic development. The 5 main causes of death were hemorrhage, heart failure, pregnancy- induced hypertension (including eclampsia), postpartum infection and liver failure.
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PMID:Maternal mortality in China. 263 3


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