AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | 31 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 3 | 2024 | An Assessment of Risk factors for Post Caesarean Section Sepsis in Tembisa Provincial Tertiary Hospital ABSTRACT Background: There is a global rise in the rate of caesarean section (CS) deliveries. Pregnancy-related sepsis is one of the most common causes of maternal morbidity and mortality in regional and tertiary hospitals. The Tembisa Provincial Tertiary Hospital (TPTH) maternity unit is amongst some of the busiest units in Gauteng, with an average of 15 600 deliveries per annum. Although data is lacking, there are numerous women who require repeat admission for the management of post CS sepsis. Appropriately identifying women with risk factors for post CS sepsis would contribute to reducing morbidity and mortality associated with post CS sepsis. This study aimed to establish the incidence of and explore the factors that contribute to post caesarean section sepsis in the maternity unit of TPTH Methods: An observational case control prospective study was conducted to survey women undergoing caesarean section at TPTH who present with post-caesarean section sepsis. Results: A total of 742 participants were reviewed. The sample consisted of women aged between 15-45 years who had a caesarean section. Of the 742 women, 43 (5.8%) presented with surgical site sepsis. Using the Fisher’s exact test of independence, there was a statistically significant association between sepsis and being HIV positive (p<0.01), having an emergency CS (p<0.1), and higher BMI score (p<0.01). Conclusion: The incidence of sepsis in this study is consistent with rates found in the literature for local and international studies. Measures aimed at monitoring and identifying existing medical conditions such as HIV and obesity in pregnancy could reduce the risk of post-operative sepsis. Keywords: Superficial sepsis, sepsis, surgical site infection, puerperal sepsis, caesarean section delivery INTRODUCTION Caesarean sections (CS) have been practised since antiquity in most cultures the world over. 1 Due to its associated maternal morbidity and mortality, CS delivery was cloaked in mysticism 1 . The factors that contributed to CS fatality centuries ago, like haemorrhage and sepsis, still pose a challenge today. 1-3 CS delivery is currently one of the most common procedures performed globally. 3 According to the 2023 Saving Mothers report, The South African CS delivery rate is increasing ( 32.3% vs 28% in 2023 and 2022). 4 The CS delivery case-fatality rate (CFR) was 122.3 deaths per 100,000 CSs. 4 Surgical site infection is not only a significant cause of morbidity and mortality, but is associated with longer hospital stays, readmissions and added costs. 1,3 In America, surgical site infection is estimated to cost US $3.3 billion annually. 5 Surgical site infections are categorised into three broad categories, including superficial surgical site infection which involves the skin and subcutaneous tissue. Deep surgical site infection extends to deep soft tissue, fascia and the muscle layer, and organ or space surgical site infection with systemic involvement extending to multiple organs. 5 Endometritis is also a type of post CS sepsis in which organ space is involved. 3,5 The Saving Mothers triennium report of 2015-2017 reports mortality risk from CS at three times that of vaginal delivery (1.5/100000 vs 0.5/100000). 6 A study done at the Chris Hani Baragwanath Academic Hospital (CHBAH) reports sepsis rate associated with CS at 12.5% with 1.5% requiring admission and 11% with mild symptoms. 7 The CHBAH study, notes that the limitations to the study were the 14 day follow up period and loss to follow up. By comparison, a study at the Tygerberg Hospital in the Western Cape found that post CS related sepsis was 4.69%. 8 The lower incidence at Tygerberg Hospital and other studies could be due to differences in definitions of surgical site infections and perhaps, differences in the population studied. 7,8 Using the Surviving Sepsis Guidelines, PPattinson et.al ., 9 looked at 158 maternal deaths due to sepsis in South Africa between 2014 and 2016. They found a sepsis mortality rate of 11%. 9 Factors contributing to mortality included late presentations, inadequate resuscitation and missed/ incorrect diagnosis at the time of triage and assessment. The burden of sepsis and risk factors have been documented in other sub-Saharan regions. 10 Extremes of age and nulliparity have been identified as risk factors for post CS sepsis. 11,12 Obesity also increases the risk significantly. 12 Conner et al., stratified the risk of post CS sepsis with increasing body mass index (BMI) and found a positive correlation. 11 Sepsis risk ranged from 9.2% in women with BMI of 30-35kg/m2, peaking at 22.9% in women with BMI > 50kg/m2. 11,12 High BMI put women at risk of longer operation time, intraoperative haemorrhage, extended incisions and more midline incisions. 12-14 Smoking is also associated with an increased risk of post CS sepsis as it is associated with poor tissue perfusion. 15 Anaemia is also a challenge among pregnant women. It is a common risk factor associated with surgical site infection. 3-6 Tinei Nzenza 1 , Matuma Setati 1 , Mthokozisi Mlilo 2 , Eckhart Buchmann 3 , Lerato Langa-Mlambo 1 , Spencer Nkosi 1 1 Department of Obstetrics and Gynaecology, University of Pretoria, Faculty of Health Sciences, School of Medicine 2 University of the Witwatersrand, Faculty of Commerce, Law and Management 3 University of the Witwatersrand, Faculty of Health Sciences CORRESPONDENCE: T Nzenza | Email: tnzenza@gmail.com An Assessment of Risk Factors for Post Caesarean Section Sepsis in Tembisa Provincial Tertiary Hospital