Sunday, 2 September 2018

Maternal Sepsis: Hidden Infection That Makes Safe Motherhood Traumatic, Deadly


Chioma Umeha


For many women in Nigeria, a country with one of the highest maternal death rates in the world, the prospect of giving birth can be scary.
The United Nations Children’s Fund (UNICEF) says more than 150 women die every day in pregnancy-related = in Nigeria, an average of one death every 10 minutes.
It’s not surprising that many pregnant women worry about coming out of the hospital or clinic alive.
“I told my family members to pray for me,” says Mary Onyema, a mother of two. “I am sure that is why I am alive today.
“I nearly died of childbirth complications during my first delivery,” she says. “I had infection in the genital tract, miscarriage and this was accompanied with fever, pain in the lower abdomen and an ill-smelling vaginal discharge.”
Despite her fears, Mary counts herself lucky because she was in a private clinic.
“The situation is worst in public hospitals,” she says. “The workers are not motivated and emergency services are almost absent. I don’t know what would have happened to me if I had gone there.”
Mary’s case represents several hundreds of thousands. Though the annual maternal mortality rate from maternal infections in Nigeria has dropped over the years, maternal and postpartum sepsis remains quite significant.
In March 2013, the Society of Gynaecology and Obstetrics of Nigeria reported that 17 per cent of the 11,600 maternal deaths were recorded in Nigeria were attributable to infection during pregnancy.
As one of the top three leading causes of maternal and neonatal deaths in Nigeria, maternal sepsis is an illness that can develop in some pregnant women as well as women who have recently put to bed.
WHO defines maternal sepsis as infection of the genital tract occurring at any time between the onset of the rupture of membranes or labour and the 42nd day postpartum in which fever and one or more of the following are present: pelvic pain, abnormal vaginal discharge, abnormal odour of discharge, and delay in the rate of reduction of size of the uterus.
The world health body further describes sepsis as a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs.
It says; “As infections frequently complicate serious diseases, sepsis is a final common pathway to death from both communicable and non-communicable diseases around the world.
“If sepsis develops during pregnancy, while or after giving birth, or after an abortion, it is called maternal sepsis.”
INDEPENDENT finding shows that sepsis can occur because of an infection related to the pregnancy or one that is totally unrelated, such as pneumonia or Urinary Tract Infection (UTI).
Sepsis can also develop as the result of many complications such as miscarriages (spontaneous abortions) or induced abortions.
The WHO says maternal sepsis that develops within six weeks of delivery, is called postpartum sepsis or puerperal sepsis while neonatal sepsis is sepsis in new born babies.
Despite being highly preventable, the UN health body worries that maternal sepsis continues to be a major cause of death and morbidity for pregnant or recently pregnant women.
“Infections are the primary cause of approximately 35 000 maternal deaths every year. As a primary or contributing cause, sepsis can be associated with up to 100 000 maternal deaths every year.”
Perhaps more worrisome to WHO is that maternal sepsis has received less than adequate attention, research and programming, despite being known as the third most common direct cause of maternal mortality.
Undetected or poorly managed maternal infections lead to sepsis, death or disability for the mother and other adverse outcomes.
Maybe more worsening is that health experts recognise that maternal and postnatal sepsis are leading causes of maternal deaths, yet strategic approaches in past years have mainly focused on clinical interventions and health system strengthening. Possibly of greater consequence, bigger attention has been on other leading direct maternal death causes such as postpartum haemorrhage and hypertensive disorders.
In addition, health workers are also often unaware of the signs and symptoms of sepsis and so are unable to recognise the condition and treat it in time.
Risk factors
INDEPENDENT investigations show that when health facilities are overcrowded and poorly resourced, women are at greater risk of infection and sepsis. Women who undergo caesarean sections in such conditions are at even greater risk.
Dr Olawoyin Imoisili, an Assistant Director and Reproductive Health Focal Person in the Lagos State Health Service Commission, confirms to INDEPENDENT that non-sterile abortions, including, those that may be done outside of a healthcare facility, are a particular risk.
“However, women with diabetes, and those that undergo invasive procedures such as IVF to help them get pregnant are at higher risk.”
Imoisili who trained in Russia and the United Kingdom is key to the Lagos State Maternal, Newborn Health (MNH) programmes observed that maternal sepsis is a severe bacterial infection usually of the womb.
Her words; “During pregnancy, the body changes, so a woman who just delivered is under pressure. Women who have had a spontaneous or elective abortion particularly when the foetus is already taking shape, should watch for signs and symptoms of an infection.”
The Reproductive Health specialist explains; “The longer the period between the ‘water breaking’ and the baby’s birth, then the higher and the chance of an infection.
Septic shock: “Septic shock occurs because of severe sepsis, which is the severe aftermath of uncontrolled infection. Both have similar symptoms, such as severely low blood pressure. However, sepsis can cause changes in mental state (shock) and widespread organ damage.
Diagnosis: Diagnosing sepsis in a pregnant woman or one who has recently given birth can be challenging.
It also may be more difficult to diagnose infections in pregnant and postpartum women. For example, UTIs usually cause a frequent need to urinate, but this can happen because of pregnancy alone.
“So if a woman is going to the rest room a lot, she may just think she is just pregnant and not realise that she has an infection. Pregnant women and new mothers need closer attention for signs of potentially fatal sepsis.
“Sepsis can potentially be very serious, as it can cause a rapid fall in blood pressure (septic shock), which can lead to multiple organ failure. If untreated, sepsis can be fatal,” adds Imoisili.
Prevention: One of the greatest tragedies of the thousands of deaths caused by sepsis is that they could have been easily prevented.
It is essential to adopt good hygiene such as hand washing after giving birth, having a thorough bath regularly, and also ensure that the perineum (space between the vaginal and anal openings) are clean.
The woman should also endeavour to gently wipe from front to back in order to miminise risk of bacterial infection to the bladder or birth canal while also changing maternity pads frequently.
Other prevention tips for sepsis in pregnancy include proper handwashing before cooking and eating.
People with diabetes, cancer, and women in their early 30s need to be extra cautious about hygiene and infections. The chances of sepsis increase since they have weak immune system.
Dr Tedros Ghebreyesus also outlines what can be done to reduce the risk of sepsis in recent online video address: access to clean water and sanitation; access to quality care during pregnancy and birth; responsible and timely access to the right medicines.
In addition, health workers need to be adequately trained and skilled to be able to recognise the signs of sepsis and to treat the condition effectively, the video shows.






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