Incidence, treatment and outcome of peripartum sepsis.
METHODS
Clinical and microbiological features of maternal sepsis in the peripartum period (7 days before to 7 days after delivery) were analyzed to determine possible risk factors, optimal treatment and outcome. In 43 483 deliveries during 1990-98, laboratory-confirmed bacteremia was found in 41 (5.1%) out of 798 clinically suspected septic infections.


RESULTS
Preterm deliveries were associated with a crude 2.7-fold risk for peripartum sepsis as compared to term deliveries. Antepartum sepsis was associated with a crude 2.6-fold risk for cesarean section, while postpartum sepsis was 3.2 times more likely to occur after cesarean section than after vaginal delivery. A combination of cefuroxime and metronidazole was used in 80% (33/41) of all treatments. All mothers recovered well, and only one suffered from septic shock. In total, 42 bacterial strains, representing 18 different bacterial species, were isolated from the blood cultures; 37 strains (88%, 37/42) were aerobic and five (12%, 5/42) were anaerobic. The most common species were betahemolytic streptococci, Escherichia coli and Staphylococcus aureus. Most microbes (81%, 34/42) were found to be susceptible to first- or second-generation cephalosporins.


CONCLUSIONS
Our analysis shows that peripartum sepsis is associated with preterm pregnancies and cesarean sections. Treatment of peripartum sepsis with second-generation cephalosporin is usually effective, and the outcome is good.
Kankuri
Esko
E
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Kurki
Tapio
T
Carlson
Petteri
P
Hiilesmaa
Vilho
V
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000209:etiology* / Q000382:microbiology / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011645:Puerperal Infection / Q000150:complications* / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications* / Q000382:microbiology / Q000628:therapy*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins