International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2019): 7.583 Volume 9 Issue 5, May 2020 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Maternal Mortality and Morbidity Caused by Puerperal Sepsis at Omdurman Maternity Hospital (OMH), Sudan 2017 Kuna A 1 , Elhussein OG 2 , Salah Ismail 3 , Khadiga Abdallah 4 , Suaad Elnour 5 , Murwan I Omer 3 , Sahar A Alfaki 4 , Umbeli T 5 1 MD, Associate Professor, Department of OBGYN, University of Bahri, Sudan 2, 3, 4, 5 MD, Associate Professor, Department of OBGYN, OIU 6 MRCOG, Consultant Obstetrician and Gynecologist, Director General, OMH 7 MBBS, Resident Registrar, OBGYN, OMH 8 Professor, MD. FCM. PhD, Department of OBGYN and Community Medicine, Faculty of Medicine, Omdurman Islamic university (OIU) Abstract: Background : Puerperal sepsis is a life threatening condition triggered by infection. It is a common cause of maternal mortality and morbidity and the third direct cause of maternal death in Sudan. Objectives : To study maternal mortality and morbidity from puerperal sepsis and to indentify its associated risk factors at Omdurman maternity hospital (OMH) 2017. Methodology : This is a descriptive observational, cohort, hospital based study, conducted at (OMH), during 2017. All women who delivered or admitted to OMH during puerperium and diagnosed as puerperal sepsis were included in the study after an informed consent. Data was collected by trained data collectors using a structured format. Included variables were; detailed history and examination, socio- demographic characteristics, obstetric profile, management received, admission to intensive care unit (ICU) and maternal mortality and morbidity. Data was analyzed using SPSS version 21. Results : During the study period, a total of 36204 deliveries were reported, 25813 (71.3%) were vaginal deliveries and 10391 (28.7%) were cesarean section (C/S). Out of them, 133 were diagnosed as puerperal sepsis, 60 (45.1%) delivered vaginally and 73 (54.9%) by C/S. Rate of puerperal sepsis in this hospital was 0.37%, o.23% for vaginal delivery and 0.7% for C/S. Common risk factors were; repeated vaginal examination 35 (26.3%), prolonged labour 30 (22.6%) and prolonged rupture of membranes 23 (17.3%). Frequently associated with middle age (21-30 years) 71 (53.4%), multiparity 61 (45.9%), illiteracy 48 (36.1%) and rural residence 81 (60.9%). Mostly presented with; fever 77 (57.9%), foul smelly vaginal discharge 31(23.3%) and abdominal pain 12 (09.0%). Thirty six (42.4%) developed septicemia, 28 (21.0%) were admitted to intensive care unit (ICU) and nine died, with fatality rate of 6.8%. Conclusion : Puerperal sepsis is a common preventable public health problem, with high maternal mortality. Main risk factors are related to childbirth and interventions during labour, where optimal antiseptic measures are needed throughout the process of labour. Low rate in this hospital may be due to strict efforts for infection prevention. Keywords: puerperal sepsis, vaginal delivery, caesarean section, Sudan 1. Introduction Puerperal sepsis is a major cause of maternal morbidity and mortality, where early identification and prompt treatment should be given immediately following the diagnosis (1). It was defined by the WHO; as a life threatening condition with organ dysfunction resulting from infection during pregnancy, child birth or puerperium (2). It is a preventable health problem causing maternal mortality and morbidity in both developed and developing countries (3). It is the third cause of direct maternal mortality in developing countries as well as in Sudan (4,5). It may be a result of chorioamnionitis, endometritis (with or without retained products of conception), wound or C/S infection, perineal tear or lactational mastitis. Usually presents with fever, foul smelly vaginal discharge, pelvic pain and sub involution of the uterus. . Sepsis should be suspected when infection is accompanied by two or more of the systemic inflammatory response syndrome (SIRS) criteria (6). SIRS criteria include; fever, (temperature of 38.3 degree centigrade), or hypothermia (temperature of less than 36 degrees), tachycardia (pulse rate is more than 90 pbm), tachypnea (respiratory rate more than 20 per minute) and WBC is more than 20 or less than 4 thousands (6). This may be associated with or without rigors, acutely altered state, hypotension or hypoglycemia. When the condition is associated with organ dysfunction or poor tissue perfusion, it is called severe sepsis. However, when hypotension failed to respond to fluid therapy the condition is called septic shock (6). It is related to poor hygiene during delivery and postpartum. Its common risk factors include; home delivery, prolonged rupture of membranes, repeated vaginal examinations, prolonged labour, instrumental delivery, post partum haemorrhage (PPH), multiparity, cesarean section (C/S), low socio-economic conditions, poor nutrition, overweight, or obesity. Common source of infection could be exogenous from external contamination or endogenous from organisms colonizing female genital tract. It is complicated by sepsis, endotoxic shock, peritonitis, abscess formation and poor obstetric future. It can be prevented by; hand washing, prophylactic antibiotics and good post delivery hygiene. However, early detection, accurate diagnosis and optimal treatment strategies are essential to improve outcomes and Paper ID: SR20428193712 DOI: 10.21275/SR20428193712 128