Tesfaye Talelign, Samuel Serawit, Lera Temesgen
Hawassa University Referral Hospital, Hawassa, Ethiopia.
School of Public Health, Wolaita Sodo University, Wolaita, Ethiopia.
Heliyon. 2023 Mar 23;9(4):e14809. doi: 10.1016/j.heliyon.2023.e14809. eCollection 2023 Apr.
World health organization reported that from 358,000 maternal deaths occurring during labor and childbirth about 15% were attributed to puerperal sepsis. In Ethiopia, puerperal sepsis is the fourth leading direct cause of maternal death next to hemorrhage, obstructed labor, and pregnancy-induced hypertension. Early recognition and management of the contributing factors would help to modify the problem. Therefore, this study was aimed to identify the determinants of puerperal sepsis among postpartum women at Hawassa city public hospitals in South Ethiopia.
& materials: Institution-based unmatched case-control study was conducted among 305 postpartum women (61 cases & 242 controls; with a ratio of 1:4) at Hawassa city public hospitals from June 17 to August 20/2021. Cases were all postpartum women admitted with puerperal sepsis and controls were randomly selected postpartum women admitted with other cases. A pre-tested interviewer-administered questionnaire was used to collect the data. Data were entered into Epi data version 4.6 and then exported to STATA version 14 for analysis. Bivariable analysis was performed and variables having a p-value <0.25 made candidates for the multivariable logistic regression model. Adjusted Odds ratio (AOR) with 95% confidence interval was computed to identify the presence and strength of association and statistical significance was declared at p-value <0.05.
In this study, a total of 61 cases & 242 controls were included. Cesarean section delivery (AOR = 2.85; 95% CI; 1.36-5.98), manual removal of placenta (AOR = 6.0; 95% CI = ; 0.39-26.26), ≥5 times Per-vaginal Examination during labor (AOR = 4.53; 95% CI; 2.10-9.80), presence Gestational Diabetes Mellitus (AOR = 8.50; 95% CI; 1.99-36.33) & prolonged labor (AOR = 3.43; 95% CI; 1.20-9.76) were identified as determinants of puerperal sepsis.
In this study, cesarean delivery, Per-vaginal Examination ≥5 times during labor, manual removal of placenta, Gestational Diabetes Mellitus & prolonged labor were factors that significantly increased the odds of developing puerperal sepsis among postpartum women. So, labor & delivery procedures should be conducted as per labor & delivery management protocols.
世界卫生组织报告称，在分娩期间发生的35.8万例孕产妇死亡中，约15%归因于产褥期败血症。在埃塞俄比亚，产褥期败血症是孕产妇死亡的第四大直接原因，仅次于出血、难产和妊娠高血压。早期识别和处理相关因素将有助于改善这一问题。因此，本研究旨在确定埃塞俄比亚南部哈瓦萨市公立医院产后妇女产褥期败血症的决定因素。
2021年6月17日至8月20日，在哈瓦萨市公立医院对305名产后妇女（61例病例和242例对照；比例为1:4）进行了基于机构的非匹配病例对照研究。病例为所有因产褥期败血症入院的产后妇女，对照为随机选择的因其他病例入院的产后妇女。使用经过预测试的访谈式问卷收集数据。数据录入Epi data 4.6版本，然后导出到STATA 14版本进行分析。进行了双变量分析，p值<0.25的变量成为多变量逻辑回归模型的候选变量。计算调整后的比值比（AOR）及其95%置信区间，以确定关联的存在和强度，并在p值<0.05时声明具有统计学意义。
本研究共纳入61例病例和242例对照。剖宫产分娩（AOR = 2.85；95%CI：1.36 - 5.98）、人工剥离胎盘（AOR = 6.0；95%CI：0.39 - 26.26）、分娩期间经阴道检查≥5次（AOR = 4.53；95%CI：2.10 - 9.80）、患有妊娠期糖尿病（AOR = 8.50；95%CI：1.99 - 36.33）和产程延长（AOR = 3.43；95%CI：1.20 - 9.76）被确定为产褥期败血症的决定因素。
在本研究中，剖宫产、分娩期间经阴道检查≥5次、人工剥离胎盘、妊娠期糖尿病和产程延长是显著增加产后妇女发生产褥期败血症几率的因素。因此，分娩和接生程序应按照分娩管理协议进行。
