Maternal Sepsis and associated factors: A multi-central study from two tertiary care hospitals of South Punjab, Pakistan.

Abstract

Objective: To determine the risk factors and outcomes of maternal sepsis.

Methods: This case-control study was performed at the departments of Obstetrics & Gynecology, Nishtar Hospital, Multan, and Ghazi Khan Hospital, Dera Ghazi Khan, Pakistan, from June 2023 to May 2024. Cases were comprised of females aged 18-45 years diagnosed with maternal sepsis, and admitted during the study period. Controls were randomly selected females reporting during the study period and undergoing delivery. Sepsis was labeled on the basis of positive blood culture report. Crude and adjusted odds ratio with 95% confidence interval were reported regarding various risk factors of maternal sepsis as well as maternal and fetal outcomes taking p<0.05 as significant. Mortality was noted from the onset of labor until seven days postpartum.

Results: In a total of 74 women (37 in each group), the mean age and, gestational age were 30.64±5.12 years, and 36.19±1.84 weeks, respectively. Multivariate binary logistic regression showed that gestational age below 37 weeks (AOR: 5.22; 95% CI: 1.35-19.67; p=0.015), unbooked cases (AOR: 5.34; 95% CI: 1.19-24.2; p=0.029), and anemia (AOR: 8.13; 95% CI: 1.05-63.10; p=0.045) were significant predictors of maternal sepsis. E. coli was the most common etiological agent among cases, affecting 14 (37.8%) cases. Mortality was significantly high among females with maternal sepsis versus those without maternal sepsis (32.4% vs. 2.7%, p=0.008).

Conclusion: Gestational age below 37 weeks, lack of antenatal booking, and anemia were found to be significant predictors of maternal sepsis. E. coli was the most common pathogen identified. High mortality rate in maternal sepsis highlights the need for early identification, effective management, and close monitoring to reduce maternal mortality from sepsis.