Rwabizi Denis, Rulisa Stephen, Findlater Aidan, Small Maria
Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda.
Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda.
BMC Pregnancy Childbirth. 2016 Jul 20;16(1):177. doi: 10.1186/s12884-016-0951-7.
The objective of this study is to evaluate 'near miss' and mortality in women with postpartum infections.
We performed a retrospective review of all patients referred to the University Teaching Hospital of Kigali (CHUK) between January 2012 and December 2013. We identified 117 patients with postpartum infections. Demographic data, length of admission, location of referral, initial surgery and subsequent treatment modalities including antibiotic administration and secondary surgery were recorded. The primary outcome of interest was a composite of maternal mortality and "near miss" defined as more than one laparotomy with/without hysterectomy and prolonged hospitalization.
Diagnoses at CHUK were: pelvic peritonitis (56 %), deep surgical site infection including fasciitis (17 %), and endometritis (15 %). The primary procedures performed prior to transfer were: cesarean section (81 %), septic abortion management (12 %), and vaginal delivery (7 %). Antibiotics were initiated prior to transfer in 66 % of women. Surgery was required in 73 % of patients. Hysterectomies were performed in 22 % of patients. Maternal death occurred in 5 % of the patient population. The primary outcome of severe maternal morbidity and mortality occurred in 90 patients (77 %).
Peritonitis-primarily as a result of cesarean deliveries-is associated with significant morbidity and mortality in our population.
本研究的目的是评估产后感染女性的“险些发生的严重事件”和死亡率。
我们对2012年1月至2013年12月转诊至基加利大学教学医院（CHUK）的所有患者进行了回顾性研究。我们确定了117例产后感染患者。记录了人口统计学数据、住院时间、转诊地点、初次手术及后续治疗方式，包括抗生素使用和二次手术。主要关注的结局是孕产妇死亡和“险些发生的严重事件”的综合情况，“险些发生的严重事件”定义为进行一次以上剖腹手术（伴或不伴子宫切除术）及住院时间延长。
在CHUK的诊断结果为：盆腔腹膜炎（56%）、包括筋膜炎在内的深部手术部位感染（17%）和子宫内膜炎（15%）。转诊前进行的主要手术为：剖宫产（81%）、感染性流产处理（12%）和阴道分娩（7%）。66%的女性在转诊前开始使用抗生素。73%的患者需要进行手术。22%的患者接受了子宫切除术。5%的患者发生了孕产妇死亡。90例患者（77%）出现了严重孕产妇发病和死亡的主要结局。
在我们的人群中，腹膜炎（主要由剖宫产导致）与显著的发病率和死亡率相关。
