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Nancy L Sloan, DrPh, International Programs Division, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, 2123390601, nsloan@popcouncil.org, Nguyen Thi Nhu Ngoc, MD, Medical Director, Hung Vuong Hospital, 128 Hung Vuong Street, Ho Chi Minh City, Q5, Vietnam, and Beverly Winikoff, MD, MPH, Gynuity Health Projects, 15 E 26 Street, Suite 1609, New York, NY 10010.
Postpartum infection is rarely clinically evaluated and is probably underestimated as is its contribution to maternal mortality in developing countries. We conducted a prospective study of non-surgical postpartum infection, identified after vaginal delivery by clinical and laboratory examination prior to hospital discharge and again at six weeks postpartum, in Ho Chi Minh City. Textbook definitions, physicians’ diagnoses, symptomatic and verbal autopsy definitions were used to estimate infection. Student’s t-test and Mantel-Haenszel chi-square statistics were used to compare incidence rates. 978 consecutive, eligible consenting women were followed-up at 46±14 days postpartum. The most conservative estimate of postpartum infection was 1.7%. The incidence of serious infection was 0.5%, but increased to 4.6% when verbal autopsy and symptomatic definitions were used. Postpartum infection, particularly serious infection, is greatly underestimated. While antibiotics are widely available in developing countries, they may be frequently misused and their misuse may leave women particularly vulnerable to severe postpartum infection. In our sample, 98% of women received antibiotics before discharge, as had all but one of the 53 woman identified with postpartum infection.
Maternal mortality continues to be, in large part, attributable to poor access to adequate obstetric care. Theoretically feasible means to prevent and treat postpartum infection outside of health care facilities in developing countries, such as improving postpartum services to ensure examination, detection and treatment of infection, and providing micronutrient supplementation to reduce the incidence and severity of infection could avert a greater proportion of maternal deaths, solely or collaterally due to postpartum infection, than presently expected.
Learning Objectives:
Keywords: Safe Mother Program, International MCH
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.