Determinants and aetiologies of postpartum pyrexia; a retrospective analysis in a tertiary health facility in the Littoral Region of Cameroon

Abstract

Background: Postpartum febrile morbidity is relatively common, occurring in approximately 5-7% of births. Differentiating between potentially serious and benign causes of postpartum pyrexia (PP) is fundamental in curbing the mortality rate from sinister causes such as sepsis. The paucity of data on PP in Cameroon makes it difficult to access its actual burden. This study was aimed at determining the prevalence, risk factors and aetiologies of PP at a tertiary hospital in Douala, Cameroon. Methods: This was a 2year hospitalbased retrospective cohort study carried out at the Douala General Hospital (DGH), during which medical records of all postpartum admissions between January 1st 2017 and December 31st 2018 were reviewed. The review consisted of collecting data on socio-demographic characteristics, clinical profile, investigations and final diagnoses. The collected data was analysed in SPSS 23.0. Chi-squared test was used to test the association between variables and a logistic regression analysis was fitted to identify risk factors associated to PP. Results: A total of 1520 postpartum files were reviewed. The prevalence of PP was 8.82%. The most frequent causes of PP were: malaria (46.7%), urinary tract infections (18.7%), puerperal sepsis (17.9%) and pneumonia (8.7%). E. coli was the most (49.3%) cultured germ isolated in positive cultures. Onset of PP was more common (85%) within the first 3 days postpartum and malaria (60%) was the leading aetiology within this period. Five or more vaginal examinations prior to delivery (OR 59.151, 95% CI: 21.463-163.019; p < 0.001), perineal tears (OR 45.157, 95% CI: 2.266-899.722; p < 0.001), and duration of labour > 18 h (OR 26.760, 95% CI: 7.100-100.862; p < 0.001) were the most significant risk factors associated with PP. Conclusion: Approximately 1 in every 12 postpartum cases in the DGH presents with PP. Malaria was the leading cause of PP at DGH especially for cases registered within 3 days postpartum. The risk factors identified were mostly associated to perinatal events, such as frequent vaginal examinations, perineal tears and prolonged labour. Efforts towards preventing identified risk factors thus becomes paramount in order to curb this high rate of PP in the DGH.

Prevalence of Maternal Fever and Associated Factors among Postnatal Women at Kawempe National Referral Hospital, Uganda: A Preliminary Study

“…Therefore, healthcare givers should ensure close monitoring of mothers’ body temperatures even several days after birth for the timely detection of fever and, thus, timely diagnosis of postnatal infections such as puerperal sepsis. This finding is in line with the findings of a study conducted in Cameroon, which stated that postnatal fever was more common in the first 3 postnatal days, excluding the first 24 h [ 33 ]. The same study also emphasized that the timing of the onset of fever is an important management strategy for healthcare providers for the timely management of postnatal infections and other complications.…”

An ultrasound observation study on the levator hiatus with or without diastasis recti abdominis in postpartum women

“…Our data also showed that perineal tearing is more likely to occur in the DRA and VD group. Perineal tear was one of the risk factors identified for some diseases, and the question of whether DRA causes perineal tearing, or vice versa, is worth further study [25]. One possibility for the connection between vaginal delivery and perineal tearing could be the inward contraction of abdominal muscles, particularly uterine, during delivery.…”

Clinical characteristics and management in women with postpartum infection

“…Có 27 trường hợp NTHS trong mẫu nghiên cứu có chuyển dạ kéo dài (chiếm tỷ lệ 67,5%), cao hơn nhóm không có chuyển dạ kéo dài (chiếm 32,5%) với p < 0,05. Ngunyi và cộng sự (2020) đã chỉ ra rằng, thời gian chuyển dạ kéo dài trên 18 giờ làm tăng khả năng mắc nhiễm trùng hậu sản với OR = 26,760 (95% CI, 9,081 -63,218) [12]. Kết quả từ nghiên cứu của chúng tôi so với nghiên cứu trên có sự tương đồng với việc chuyển dạ kéo dài làm tăng tỷ lệ NTHS.…”