post natal sepsis

Firstly sorry for the very long period of no blogging, a combination of being busy and rubbish internet got the better of me!

So this post is dedicated to one of my patient who i looked after for a month before she lost her life to sepsis.

She had a normal delivery, slightly prolonged labour but not too bad, a few days after she started complaining of abdominal pain, distension and vomiting- she was seen by another doctor and diagnosed with bowel obstruction, i saw her 2 days after that and thought she had endometritis- for the non medics that an infection of the uterus- i started her on strong IV antibiotics and observed 2 days later she was no better.  I have learnt by being here that you have to be quite aggressive in the management of these patients if they are to survive so i booked her for theater.  During her operation she had thin pus in her abdomen and a very infected, uterus that was starting to undergo necrosis- so we had to remove her uterus.  she has a few babies and this baby also survived but i have has some really young first time mums with very lengthy obstructed labour who end up having a c-section, after which their baby dies and then they get severe sepsis followed by a hysterectomy- it breaks my heart! But as my consultant says better alive without a uterus then dead with one.  Anyway back to my patient after her hysterectomy she was a little better but a few days later her abdomen was starting to become distended again despite being on antibiotics.  5 days from the hysterectomy she was still getting worse so it was time for another operation... this time she had accumulated an abdomen full of pus again, a washout and 2 large drains later she was back on the ward.  we sent some pus for microbiology and it grew klebsiella and group a strep resistant to pretty much everything except ciprofloxacin - we weren't winning here!  The drains became blocked and stopped draining and she started having high temperatures again, and a week later we were back in theatre with an abdomen full of pus again!  After this operation she started having intermittent seizure, we looked at all the common causes and she had none of these- so we fought for an MRI which showed a clot in the brain- thats a bit of a life sentence in malawi coupled with her still being very septic we werent going to win :(.  She was so lovely may she rest in peace, my thoughts are with her family, her three young kids and new born baby.

Purpural sepsis is still one of the leading causes of maternal mortality world wide, a combination of non sterile conditions, lack of antibiotics, long labours all play a part.

We don't always loose though- another of my patients finally went home after 2 months following a ruptured uterus,  c-section and hysterectomy, neonatal death, sepsis, laparotomy and wash out X2, Vesico Vaginal Fistula from the obstruction which caused the rupture,   VVf repair and now shes gone home in great condition :)