AFJOG

African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | 20 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 3 | Issue 1 | 2025 | Maternal deaths due to Pregnancy-Related Sepsis arising from bowel injury: A retrospective folder review from the NCCEMD triennium 2020-2022 NCCEMD. In addition, a seperate file review of women who died from maternal sepsis related to bowel injury between 2020-2022 was performed after permission from the NCCEMD. Permission to publish the study was granted by the National Department of Health (NDOH). We examined the entire clinical records in detail. Data were extracted using a standard data collection sheet in the form of a checklist, and subsequently entered in an Excel spreadsheet. Descriptive statistics were calculated and reported. There is no control group. RESULTS According to the Saving Mothers’ report (2020-2022), 172 women died because of PRS, which is similar to the 2017- 2019 triennial period. Of the 172 PRS cases, 17 cases (10%) were due to bowel injury after caesarean section. There were 188 maternity case records labelled as PRS maternal mortality cases. Of these, 16 cases were excluded because they were not PRS maternal deaths. Of the remaining 172, there were 16 cases of maternal death due to bowel injury. Fourteen of these cases (88%) had complete case records that were evaluated. This study is based on the 14 cases of bowel injury with complete records (figure 1). Figure 1: PRS cases assessed for 2020-2022 188case records received Included 176Pregnancy RelatedSepsis 172PRS (155 PRS excluding 14 Bowel injuries 2 Bowel injury (incomplete records & one bladder injury 4excluded (incomplete records) Excluded 12cases 1Ectopic Pregnancy,1PPH,1HPT,9AC - Since 2008, there has been a steady exponential increase in PRS cases from bowel trauma at caesarean delivery over the years (Figure 2). Figure 2: PRS numbers with the rise in bowel injury cases over 5 trienniums 2008-2010 2011-2013 2014-2016 2017-2019 2020-2022 Total PRS 258 226 184 170 172 NVD 131 117 84 76 71 CD 115 88 100 69 71 B.trauma @CD 2 11 14 18 17 0 50 100 150 200 250 300 PRS numbers over 5 trienniums Total PRS NVD CD B.trauma @CD Expon. (B.trauma @CD) DEMOGRAPHICS AND RISK FACTORS The demographic profile and risk factors of women who died of complications related to bowel injury are described in Table 1. Eight (57.1%) of the women who died were in the age group 25-34 years, 10 (71.4%) were HIV positive, and 10 (71.4%) had increased BMI. Eight maternal deaths (57.1%) occurred in regional and tertiary hospitals combined. The mean age of affected women is 31 years. Viral load was available in nine (90%) of those who were HIV positive, and CD4 count in seven (70.0%). Table 1: Baseline data for Maternal sepsis women with bowel injury n = (14) % Age(years) 25-34 ≥35 08 06 57.14 43.86 Parity 0 1 2 3+ 02 04 04 04 14.29 28.57 28.57 28.57 Anaemia Yes No 03 11 21.43 78.57 BMI Below 18.5(Underweight) 18.5—24.9 (Healthy) 25.0—29.9 (Overweight) 30.0 and Above (Obese) Unknown 01 03 06 02 02 7.14 21.43 42.85 14.29 14.29 Prolonged labour Yes No 02 12 14.29 85.71 HIV Positive -VL measured -CD4 count available HIV negative HIV unknown 10 09 07 01 03 71.43 90.00 70.00 7.14 21.43 Number of previous CS 0 1 ≥2 06 03 05 42.86 21.43 35.71 Place of death District hospital Regional hospital Tertiary hospital Private hospital 05 04 04 01 35.70 28.60 28.60 7.10 The indications for caesarean section are listed in Table 2. Eight women (57.14%) had emergency caesarean sections for various indications. Eight (57.1%) women had previous CD, with the majority having more than one previous CD. Three (37.5%) women with previously scarred uterus had adhesions resulting in a difficult caesarean as mentioned in the surgeon’s notes. Table 2: Indications for CS Indication N (14) % Elective Caesarean Section Previous CS ≥ 2 not in labour 04 28.57 Previous CS x 1 not in labour (no other factor) 02 14.29 Emergency Caesarean Section Previous CS ≥ 2 in labour 01 7.14 Previous CSx1 in labour (no other factor) 01 7.14 Prolonged 2nd stage of labour 02 14.29