How do we reduce maternal deaths due to puerperal sepsis in South Africa?

Abstract

Puerperal sepsis remains one of the leading causes of maternal deaths in South Africa and a large number of these deaths are avoidable. The National Committee on Confidential Enquiry into Maternal Deaths (NCCEMD) identified these avoidable factors which included missed diagnoses, lack of appreciation of the severity of the disease, delay in transferring ill patients and substandard management. In order to achieve the 5th Millennium Development Goal of improving maternal health and reducing the maternal mortality rate these avoidable factors need to be addressed. One of the key recommendations of the Saving Mothers Report of the NCCEMD states that protocols on the management of important conditions causing maternal deaths (including puerperal sepsis) must be available and utilised appropriately in all institutions where women deliver and that all midwives and doctors must be trained on the use of these protocols. Health care practitioners should be aware of the risk factors for the development of puerperal sepsis, especially emergency caesarean section for obstructed labour and HIV-infection, in order to offer appropriate antibiotic prophylaxis. The signs and symptoms of puerperal sepsis should be clearly understood and an accurate initial assessment should be made so that the appropriate management can be started timeously. This includes managing the patient at the appropriate level of care, initiating appropriate antibiotic therapy, evacuating the uterus if necessary and deciding on the need for laparotomy.

Key words: Puerperal sepsis; Antibiotic prophylaxis; Maternal mortality, HIV/AIDS