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Query: UMLS:C0036690 (sepsis)
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From 1 January 1980 to 31 December 1985, 81 maternal deaths occurred at Pelonomi Hospital, Bloemfontein; these were classified as direct obstetric-related (74 cases), indirect obstetric-related (6) and non-obstetric (1). The overall maternal mortality rate was 2.87 per 1000 deliveries, including deaths related to abortion and ectopic pregnancy, but excluding the non-obstetric death. Among booked patients the maternal mortality rate was 0.32 and among unbooked patients 11.13 per 1000 deliveries. The maternal mortality rate for patients from the Bloemfontein area was 0.72 per 1000. Puerperal sepsis and postabortal sepsis accounted for 45.7% of the deaths. Avoidable factors were considered to be present in 65 cases (80.2%).
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PMID:Maternal deaths at Pelonomi Hospital, Bloemfontein, 1980-1985. A survey of 81 consecutive cases. 274 Sep 55

(ABSTRACTOne hundred and fifty five strains of Neisseria gonorrhoeae were regrown from 216 freeze dried cultures originally isolated in Zimbabwe. The gonococci were from men (61 strains) and women (39 strains) attending a referral sexually transmitted diseases (STD) clinic, from women presenting for delivery at hospital with signs of sepsis (22 strains) or with an asymptomatic infection (16 strains), and from babies with ophthalmia neonatorum (17 strains). Seventy five of the 100 isolates from STD clinic patients and 29 of the 55 isolates from hospital patients were penicillinase producing N gonorrhoeae (PPNG). Two thirds of all PPNG strains contained the 24.5 megadalton conjugative plasmid. The 3.2 megadalton resistance plasmid, usually associated with PPNG strains originating in Africa, was present in only one third of the PPNG strains. The 2.6 megadalton cryptic plasmid was present in all strains. Prototrophic and proline requiring auxotypes predominated in both PPNG and non-PPNG strains. Arginine requiring auxotypes were found in four of the 16 isolates from asymptomatic women, whereas three of the 22 strains from women with puerperal sepsis and four of the 61 strains from men with urethritis required both proline and arginine. Fifty eight out of 66 PPNG strains with the 4.4 megadalton plasmid required proline compared with 22/38 PPNG strains with the 3.2 megadalton plasmid and 20 of the 51 non-PPNG strains. Three quarters (38/51) of non-PPNG strains belonged to serogroup WII/III as did 42/66 PPNG strains with the 4.4 megadalton plasmid but only 10/38 PPNG strains with the 3.2 megadalton plasmid. In all, 23 different strain types could be recognized on the basis of plasmid content, auxotype, and serogroup. There was, however, a high degree of homogeneity between PPNG and non-PPNG isolates.
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PMID:Characterisation by plasmid profiles, serogroups, and auxotypes of Neisseria gonorrhoeae from Harare, Zimbabwe. 314 9

The history of maternal deaths in England from the earliest records in the 1700s to 1935, concentrating on the influence of medical practice, is recounted. The rate lay between 4 and 5 per 1000 until 1935, with the advent of sulfa antibiotics to prevent puerperal infections. The practice of midwifery by men began in the early 17th century in Britain, but attendance at normal labors by medical practitioners, that is, surgeon-apothecaries, did not become common, and then only in urban areas, until 1730. The use of forceps became widely known about that time, and lying-in hospitals were begun. Obstetrics was held in contempt by professionally educated and registered physicians and apothecaries, however, because of the immodesty and messiness of the work and the long hours involved. Estimates of maternal mortality, from the 1st recorded unselected series, in the late 18th century range from 5-29/1000. Some of the high figures are from specialists in obstetrics, who treated complicated cases. From these data the maternal death rate was estimated at about 25/1000 among unassisted women. Some institutions achieved results better than the national average in the 1920s, suggesting that by the end of the 18th century, a fairly good understanding of childbirth had been reached. At that time the overall forceps rate was conservative, less than 1% compared to 15% now. Use of the perforator, hook and crochet, and manual dilatation of the cervix had been abandoned. In the 19th century, lying-in hospitals became more common and their death rates were higher, probably due to less conservative methods, up to as high as 85/1000, until the advent of antisepsis in 1880. Nevertheless, hospital births were the minority, amounting to 15% in 1927, 54% in 1946, 87% in 1970, 98.8% in 1980. Sepsis, due to casual use of sterile technique, remained the cause of half the total deaths until 1937. It is difficult to assess the contribution of toxemia or obstructed labor in maternal deaths. Rickets was a common cause of obstructed labor, and there are recorded epidemics of both. Similarly, abortion-related deaths are even more difficult to estimate, because of poor reporting. In evaluating the undiminished maternal death rate before 1935, the author believes that maternal survival is remarkably resistant to the ill effects of socioeconomic deprivation, but is very sensitive to the good and bad effects of medical intervention. Hence, there is evidence that the rural and poor in some cases had better results that those given the best medical assistance, especially with regard to puerperal sepsis. The midwifery laws of 1902 provided for training of midwives, and slowly corrected quality of care, as well as hostility between midwives and physicians. The current maternal death rate is about 0.1/1000.
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PMID:Deaths in childbed from the eighteenth century to 1935. 351 35

This report studies the principal causes of maternal death at Harare Maternity Hospital. In 1983 the maternal mortality rate for the greater Harare unit was 52/100,000 compared to 11.9/100,000 for England and Wales. Puerperal sepsis, hemorrhage, post-abortal sepsis and hypertensive disease accounted for 78.5% of the deaths. 12 of the deaths were due to puerperal sepsis, 8 of which had normal vaginal delivery and 4 were delivered by Caesarian section. 3 patients died within 48 hours of delivery. Hemorrhage was most commonly a result of ruptured uterus. Avoidable factors were considered present in all cases. Delay in diagnosis, availability of blood or performing laparotomy was evident in 4 of 5 who died from ruptured uterus; 2 were due to pulmonary edema from excessive transfusion, and 2 were attributable to the patient (refusal of transfusion, attempt to self abort.) Post-abortal sepsis occurred in 9 patients, most of whom were septicemic on admission. 8 patients died from hypertensive disease, 7 of which were eclamptic. Reduction in mortality has gone from 34% (1976) to 23.7% (1983) for puerperal sepsis and can be affected by encouraging patients to book for antenatal care. An observed increase in hemorrhagic deaths since 1976 may reflect a decreased staff-patient ratio at Harare Maternity Hospital. Post-abortal sepsis mortality has decreased from 32% (1976) to 17.7% (1983). Reduction in deaths from hypertensive disease necessitates prediction and early detection. Value of a post-mortem exam in all cases of maternal death is stressed.
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PMID:The prevention of maternal deaths: a continuing challenge. 373 Dec 56

There were 51 maternal deaths at Harare Maternity Hospital, Zimbabwe, during 1983, 25 among patients from the greater Harare area and 26 among patients referred from peripheral hospitals or clinics. The overall maternal mortality rate among patients within the greater Harare area was 56/100 000 (including deaths related to abortion). Among 'booked' patients the maternal mortality rate was 29/100 000. Puerperal sepsis, haemorrhage, post-abortal sepsis and hypertensive disease accounted for 78.4% of the deaths. Avoidable factors, considered to be present in 34 cases (66.7%), are discussed.
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PMID:Maternal deaths at Harare Maternity Hospital during 1983. 394 72

33 women with severe infection of the genital tract were studied using fastidious anaerobic techniques. The women, admitted to the Department of Obstetrics and Gynecology at Cook County Hospital were referred to the Infectious Disease Service for the following: pelvic abscesses (13), tubo-ovarian abscesses (3), endometritis following dilatation and currettage (2), sepsis associated with incomplete abortion (7), puerperal sepsis (5), vaginal abscess (1), vulval abscess (1), and Bartholin's gland abscess (1). Anaerobic bacteria was cultivated from all 33 patients. Aerobic bacteria was associated with anaerobes in 21 patients, the most frequent isolate being E. coli, followed by facultative streptococci of the viridans group. 12 patients had only anaerobes present but no patients had aerobes in the absence of anaerobic forms. 12 patients also has positive blood cultures for the same anaerobes isolated from soft tissues. The 3 groups of anaerobes isolated with greatest frequency were bacteroides, peptostreptococci and clostridia. Bacteroides fragilis was the major species recovered in 26 specimens. 6 patients who had failed on conventional antibiotics were treated with clindamycin, a new antibiotic with high activity against anerobes. All patients responded satisfactorily. These bacteriologic and clinical observations suggest that anaerobes play an important and often decisive role in serious pelvic infections.
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PMID:Anaerobic infections of the female genital tract: bacteriologic and therapeutic aspects. 458 19

Postpartum infection remains a cause of considerable maternal morbidity and occasional maternal mortality. Puerperal sepsis mediated by what is now known as group A beta-hemolytic streptococci or Streptococcus pyogenes was once a common and lethal nosocomial scourge. Fortunately, multiple developments have decreased the incidence and ameliorated the clinical course of group A beta-hemolytic streptococcal postpartum sepsis. Despite these developments, epidemic group A streptococcal sepsis still jeopardizes modern mothers. We describe an epidemic of five women with group A beta-hemolytic streptococci-mediated postpartum infections which occurred at Mather Air Force Base Hospital, Sacramento, California. The remarkable, yet characteristic signs, symptoms, and clinical course of these patients are briefly reviewed along with the epidemiologic methods which led to the discovery of the common nosocomial source. Familiarization of the clinical aspects of these patients and the methods used to eradicate this epidemic will facilitate the protection and care of other women. Unfortunately, modern mothers still remain in jeopardy from "childbed fever."
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PMID:An epidemic of "childbed fever". 638 21

During 15 years (1965 through 1979), 9,718 cesarean sections were performed at Hutzel Hospital. This report concerns the indications, incidence, morbidity, and mortality. Dystocia, fetal distress, and breech presentations were the most common indications for primary cesarean section. The incidence rose from 9.8% to 16.8% during this study. Forceps deliveries dropped from 47.5% to 12.0% and vaginal breech deliveries decreased from 86% to 35%. Spinal anesthesia was used in 90%. Caesarean section hysterectomies were performed in 128. The most common indications were carcinoma in situ of the cervix, uterine leiomyoma, and hemorrhage. Puerperal sepsis and urinary tract and wound infections were the major causes of morbidity. Perinatal mortality decreased from 40% to 29%. There were 10 maternal deaths. Sepsis was the major cause of death. At least four deaths could have been avoided if ultra-high-risk patients had not been pregnant in the first place.
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PMID:Caesarean section: a 15-year review of changing incidence, indications, and risks. 722 16

In Sandaun Province in Papua New Guinea, health professionals at the health center serving the people of Aitape District (Raihu Health Centre) compared data on deliveries before arrival (DBA) at the regional hospital in Wewak with data on 635 deliveries at Raihu Health Centre (HC) to examine differences in pregnancy complications and outcomes between the DBA and HC groups. All the deliveries occurred between 1990 and mid-1992. HC delivery cases were more likely to have had prenatal care than DBA delivery cases (90% vs. 52%). Multiple births were high (4% for DBA and 3.5% for HC), as was expected in Aitape District, where multiple births are common. The multiple births accounted for a high breech delivery rate (3.5-5.4%). Proper supervision during delivery would have likely reduced the high rate of retained placentas in the DBA group (21% vs. 1.3%). Other pregnancy complications more common in the DBA group than the HC group included postpartum hemorrhage (16% vs. 4.3%), need for blood transfusion (15% vs. 2.5%), and puerperal sepsis (18% vs. 4.3%). The DBA group also had a lower hemoglobin level and a higher gonorrhea rate and stayed in the hospital longer than the HC group (7.78 vs. 8.77 g/dl, 17% vs. 8%, and 6.54 vs. 5.4 days, respectively). Infants in the DBA group were more likely than those in the HC group to die in utero (10.5% vs. 2.3%) and die during the first week postpartum (4% vs. 2.5%), develop neonatal sepsis (17.2% vs. 8.4%), and weigh less (2.68 vs. 2.81 kg). These findings suggest that mothers who receive prenatal care and deliver at a health center experience fewer complications and have bigger and healthier newborns than mothers who deliver at home.
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PMID:A comparison between health centre deliveries and deliveries born before arrival in the Aitape district. 766 55

A series of 8 cases of puerperal sepsis caused by beta-haemolytic Streptococcus from group A is analysed, including two cases of death--of a mother and her newborn. Among the women in seven cases serotype 2 of beta-haemolytic Streptococcus from group A has been identified. The cases have been observed in the Delivery department as a result of the existing favorable conditions for the transmission of the infection. Most probably among these conditions are the negligence of the sterility of the obstetric service from the moment of admission in the ward as well as the possibility for personal contacts among the patients after delivery. The late diagnosis (after two cases of death--of a newborn and a mother) can be attributed to the atypical clinical course of the disease as well as to the negligence of the existing relatively simple methods for early diagnosis. Among the mothers in two of the cases after radical surgical treatment combined with antibiotics and in all the others--after the application of high doses of antibiotics alone, the septic conditions has been overcome. The authors stress on the existing possibilities for the development of streptococcal sepsis in the era of the effective treatment of infections caused by this agent with antibiotics and once more underline the role of the penicillins in cases of septic streptococcal infections.
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PMID:[Puerperal streptococcal sepsis]. 801 Mar 98


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