Browsing by Author "Coetzer, Marsel"

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    A retrospective audit of post-caesarean sepsis at Tygerberg Hospital
    (Stellenbosch : Stellenbosch University, 2017-12) Coetzer, Marsel; Murray, L. R.; Gebhardt, G. S.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH SUMMARY: INTRODUCTION: Caesarean section (CS) is one of the most common surgical procedures performed worldwide and remains the most important individual risk factor for developing pregnancy related sepsis. Pregnancy related sepsis leads to an estimated 75 000 maternal deaths worldwide each year, with most of these deaths occurring in low and middle-income countries. According to the 2015 Saving Mothers Annual Report, pregnancy related sepsis remained the 3rd leading cause of direct maternal deaths in South Africa. In the USA, the attributable costs (per case) of post CS surgical site infection and post CS endometritis were estimated around $3500 and $3900 respectively in 2010. AIM & METHOD: To audit post-CS sepsis at Tygerberg Hospital in order to determine the incidence, as well as to describe the risk-factor profile and determine the outcome of women who develop post-CS sepsis. A retrospective audit of patient records of all women who delivered by CS in a three-month period between 1 February 2014 and 30 April 2014 was undertaken. All records were followed up for thirty days after delivery, in order to identify cases with post-CS sepsis. The CDC diagnostic criteria for surgical site infection (both superficial and deep) and endometritis were used. RESULTS: During the 3-month study period a total of 1 834 deliveries were managed at Tygerberg Hospital. Eight hundred and forty eight CS were performed, with a hospital-based CS rate of 46.24%. A total of 811 patient records were audited and 38 women with post-CS sepsis were identified. The cumulative incidence for post-CS sepsis was therefore 4.69%. Patient characteristics illustrated the high-risk nature of the patient population served by Tygerberg Hospital, with a high incidence of known risk factors for post-CS sepsis such as obesity, hypertension and HIV. Risk factors associated with post CS sepsis included: HIV infection without antiretroviral therapy (Risk Ratio 5.83, 95% Confidence Interval 1.72 – 19.77, p=0.005) and prolonged surgical duration (Risk Ratio 3.01, 95% Confidence Interval 1.10 – 8.19, p=0.03). Thirty-three women had severe post-CS sepsis and were treated as inpatients. Of these women, 12 required repeat surgery or admission to a high care or intensive care unit. CONCLUSION: Despite a post-CS sepsis incidence that compares well with high-income countries (4.69% vs. 3.5 – 8.11%) post-CS sepsis remains a significant contributor to maternal morbidity in the South African setting. Risk factors for post-CS sepsis remain multifactorial and in the setting of a referral hospital, all women should be treated as potentially at risk. Optimization of chronic medical conditions, vigilant intra-partum care, meticulous surgical technique and recognition of early signs of post-CS sepsis are essential in order to prevent maternal morbidity.