title: Maternal near miss and mortality due to postpartum infection: a cross-sectional analysis from Rwanda.
abstract: The objective of this study is to evaluate 'near miss' and mortality in women with postpartum infections.
  
  
  
  We performed a retrospective review of all patients referred to the University Teaching Hospital of Kigali (CHUK) between January 2012 and December 2013. We identified 117 patients with postpartum infections. Demographic data, length of admission, location of referral, initial surgery and subsequent treatment modalities including antibiotic administration and secondary surgery were recorded. The primary outcome of interest was a composite of maternal mortality and "near miss" defined as more than one laparotomy with/without hysterectomy and prolonged hospitalization.
  
  
  
  Diagnoses at CHUK were: pelvic peritonitis (56 %), deep surgical site infection including fasciitis (17 %), and endometritis (15 %). The primary procedures performed prior to transfer were: cesarean section (81 %), septic abortion management (12 %), and vaginal delivery (7 %). Antibiotics were initiated prior to transfer in 66 % of women. Surgery was required in 73 % of patients. Hysterectomies were performed in 22 % of patients. Maternal death occurred in 5 % of the patient population. The primary outcome of severe maternal morbidity and mortality occurred in 90 patients (77 %).
  
  
  
  Peritonitis-primarily as a result of cesarean deliveries-is associated with significant morbidity and mortality in our population.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda.|Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda.
authors.forename: Denis
authors.initials: D
authors.lastname: Rwabizi
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda. s.rulisa@gmail.com.|Department of Obstetrics and Gynecology, University Teaching Hospital of Kigali, Kigali, Rwanda. s.rulisa@gmail.com.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rulisa
authors.affiliation: University of Western Ontario, London, ON, Canada.
authors.forename: Aidan
authors.initials: A
authors.lastname: Findlater
authors.affiliation: Department of Obstetrics and Gynecology, University of Rwanda, BP 655, Kigali, Rwanda.|Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Small
mesh_terms: D000031:Abortion, Septic / Q000628:therapy; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects*; D036861:Delivery, Obstetric / Q000009:adverse effects; D004716:Endometritis / Q000209:etiology; D005208:Fasciitis / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007902:Length of Stay; D000067491:Near Miss, Healthcare / Q000706:statistics & numerical data*; D010538:Peritonitis / Q000209:etiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D012432:Rwanda / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000209:etiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Maternal mortality; Near miss; Peritonitis; Rwanda; Severe maternal morbidity