CAUSES OF MATERNAL DEATHS 2001-2005

STATES

SEPSIS

To recognise sepsis
To practise an effective response to a
woman with sepsis
To achieve competence in those skills

Principles of management
ABCs
If conscious, increase oral fluid intake and
in all start iv fluids
Use fan and tepid sponge to decrease
temperature
If shocked start iv antibiotics and
antimalarials
Treat other suspected causes

2002

2003

2004

2005

No.

No.

No.

No.

Postpartum
Haemorrhage

27

15.9

21

16.0

16

13.1

25

20.3

17

13.6

Hypertensive
Disorders in
Pregnancy

18

10.6

18

13.7

18

14.8

12

9.8

20

16.0

Obstetric Embolism

34

20.0

23

17.6

32

26.2

23

18.7

24

19.2

Associated Medical
Conditions

35

20.6

24

18.3

19

15.6

25

20.3

17

13.6

Obstetric Trauma

19

11.1

14

10.7

7.4

7.3

11

8.8

Antepartum
Haemorrhage

2.4

3.1

1.6

3.3

3.2

Puerperal Sepsis

4.1

3.8

1.6

1.6

4.0

Abortion

1.8

3.1

2.5

7.3

4.8

Ectopic

3.5

3.1

3.3

4.1

3.2

Unspecified
Complications of
Pregnancy &
Puerperium

4.7

3.1

2.5

2.4

1.6

Associated with
Anaesthesia

1.6

Others

5.3

10

7.6

12

9.8

4.9

15

12.0

170

100.0

131

100.0

122

100.0

123

100.0

125

100.0

TOTAL

Aims

2001
No.

Recognition
Fever: temperature > 38 oC
Warm extremities
Fast breathing
Increased maternal and fetal heart rate
Altered mental state
Low BP
Septic shock

Sepsis in pregnancy and

labour
Major cause of maternal mortality
Suspect if fever, preterm labour, foul
smelling watery discharge

Causes of fever during

pregnancy
UTI (pyelonephritis
(pyelonephritis))
Septic abortion
Chorioamnionitis
Chest infection
H1N1
Typhoid or non typhoid salmonellosis
Hepatitis
Meningitis
Phlebitis
Malaria
Other: TB, HIV, appendicitis etc

Causes of fever after delivery

Sepsis after delivery

Suspect if offensive lochia and boggy

uterus

Parenteral antibiotics

Puerperal sepsis

Endometritis, pelvic cellulitis, pelvic abscess,

peritonitis

Wound infection after CS

UTI
pyelonephritis

Malaria, enteric fever

Pneumonia
Mastitis, breast abscess
Phlebitis

Endometritis
Should be considered in any case of post
partum fever
May progress to pelvic abscess, peritonitis,
septic shock, or chronic pelvic infection with
infertility
Treat with parenteral antibiotics until fever free
If fever persists after 72 hours, rere-evaluate and
consider HIV status
Consider digital exploration of uterus
Consider laparotomy

Cephalosporins preferred but may not be

readily available or expensive
Combination of
Ampicillin 2g iv 6 hourly plus
Gentamicin 5 mg / kg iv every 24 hours plus
Metronidazole 500 mg iv 8 hourly

is a good option

Pelvic abscess
Give parenteral antibiotics eg AGM
Consider draining fluctuant abscess
Consider Culdotomy or laparotomy

Abdominal or perineal
wounds
If pus or fluid, remove sc sutures, drain
and debride,
debride, damp dressing in wound and
replace every 24 hours
If superficial ampicillin and metronidazole
orally
If deep and causing muscle necrosis give
penicillin, gentamicin and metronidazole iv
Necrotising fasciitis requires surgical
debridement

Peritonitis
Place NG tube and start iv fluids
Give parenteral antibiotics eg AGM
Consider laparotomy if no improvement in
2-3 days

Acute pyelonephritis

Cystitis
Give
Amoxycillin orally for 33-5 days or
Trimethorpim / sulphamethoxazole orally for 33-5 days

If infection recurs twice or more

Check C&S
Give prophylaxisprophylaxis- amoxycillin or trimethoprim /
sulphamethoxazole orally

Malaria
Can be severe in pregnant women
Likely cause of fever in pregnant woman in
endemic area
Check for malaria parasites if possible
For uncomplicated malaria give first line
treatment*
For complicated malaria give quinine 20 mg/ kg
iv in IVF Loading dose over 44-8hrs then 10
mg/kg 8 hourly till patient regains consciousness

Give

Ampicillin+gentamicin
Once fever free for 48 hours give amoxycillin
to complete 14 days of abs

For prophylaxis
Give abs for remainder of pregnancy and 2
weeks post partum

Typhoid
Suspect if persistent fever, headache,
abdominal pain, constipation,
diarrhoea, cough, palpable spleen,
relative bradycardia
Give oral ampicillin or amoxycillin for 14
days (chloramphenicol
(chloramphenicol contraindicated in
pregnancy)
pregnancy

Hepatitis
May be fulminant with encephalopathy and
liver necrosis and haemorrhage
High mortality in pregnancy
Monitor and supportive therapy

Breast infection/inflammation will

increase the risk of HIV MTCT

Breast engorgement
If baby not suckling express milk
If suckling encourage more
Express milk before suckling to soften
nipple area
Apply warm compresses and shower
before suckling
Support breasts, cold compresses
Analgesia: paracetamol

Breast infection
As for Breast engorgement

This will not be a problem in HIV positive mothers who

are not breast feeding, however those how have
opted to breast feed should be advised appropriately
when being managed for..

Breast abscess
Continue feedingfeeding-use other breast
Support and cold compresses for breast
Paracetomol
Oral cloxacillin or erythromycin for 10 days
Drain and pack
Remove or replace pack after 24 hours

Oral cloxaxilin or erythromycin for 10 days

Thrombophlebitis
Patients on IV Lines for long periods
Inflammed site, tender
May cause a fever
Treat with NSAIDS

May predispose to.

Deep vein thrombosis
Prophylaxis (IVF, early ambulation post
op, heparin and Clexane and
Treatment (Heparin
Heparin infusion, claxane)
claxane)

RECAP

Recognition of pregnancy related Sepsis

Causes
Pyelonephritis, Pnuemonia, Hepatitis
Malaria, Typhiod fever
Post op sepsis
Breast abscess
HIV
HIV.
Principles of Management