A Retrospective Study of Puerperal Infection and its Aftermath: Current Scenario from a Tertiary Healthcare Centre, Telangana, India

Abstract

Introduction: Even after decades of the development of lowcost and effective antibiotics, puerperal infections remain an important cause of preventable maternal morbidity and mortality. Aim: The aim of the present study was to determine the risk factors, morbidity, and mortality associated with puerperal infections. Materials and Methods: A retrospective study was conducted from March 2021 to October 2021, at the Obstetrics and Gynaecology Department of Gandhi Hospital in Telangana, India. The study included all women who delivered in this hospital and were referred within 42 days after delivery with fever and any of the following symptoms: pain abdomen, malodorous lochia, abdominal distention, subinvolution of the uterus, pelvic abscess, peritonitis, any system/organ failure, or shock. Various risk factors such as age, parity, socioeconomic status (according to the modified Kuppuswamy scale), BMI, rupture of membranes, mode of delivery, and comorbidities associated with puerperal infection were assessed. Complications following puerperal infection were also studied. Data analysis was performed using SPSS version 23.0, and the results were presented in frequency and percentages of categorical variables. Results: During the study period, there were 161 cases of puerperal infection. The majority of cases were between the age group of 26-30 years, constituting 72 (44.7%) cases. Among them, 86 (53.4%) cases were multiparous, 50 (31%) cases were primiparous, 10 (6.2%) cases were second gravida, and 15 (9.3%) cases were third gravida. Lower middle-class women accounted for 67 (41.6%) cases, and 85 (52.7%) cases were in the overweight range. Prolonged premature rupture of membranes for more than 24 hours was observed in 78 (48.4%) cases. Caesarean section was the mode of delivery for 90 (56%) cases of puerperal infection cases. The most commonly associated comorbidities were anaemia in 63 (39.1%) cases, severe preeclampsia in 47 (29.1%) cases, abruption in 31 (19.2%) cases, and diabetes in 20 (12.4%) cases. Prolonged hospital stay was observed in 144 (89.4%) cases, wound gaping in 26 (16.1%) cases, and disseminated intravascular coagulation in 24 (14.9%) cases. A total of 31 (19.2%) cases of women succumbed, mostly due to multi-organ failure. Conclusion: Early diagnosis, proper ICU facilities at all levels of healthcare, timely referral to tertiary facilities, health education, and strict aseptic measures would be crucial in tackling this menace.