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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