Gas gangrene in pregnancy, delivery and abortions requiring urological and surgical management; our experiences in Port Harcourt, Nigeria

Abstract

Introduction: In spite of a high contribution of 26.7% to 35.0% of sepsis to maternal mortality in our hospital, there is little or no documentation about pyogaseous infections in pregnancy in the area. We present here a series of cases of different forms and presentations of pyogaseous infections managed at designated hospitals in Port Harcourt and its environs. Materials and Methods: Using a common proforma containing clinical and relevant laboratory tests, consecutive patients that presented to designated hospitals in Port Harcourt and its environs with normal and complicated pregnancies, deliveries and abortions were evaluated. Those with diagnosis of gas gangrene were treated and enlisted in this study. Socio-demographic and clinical data including outcome of all investigative and therapeutic procedures in pregnancy, puerperium and abortions were recorded. Results were presented. Results: One thousand five hundred and eighty-three (n=1583) patients were evaluated. Five (5) patients (aged 19-35years) had features of gas gangrene. One patient had gas gangrene in the mid-trimester of pregnancy. In three the disease complicated abortions; one after Cesarean section done for complicated term pregnancy. Two patients survived. Three died in spite of treatment. Conclusion/ Recommendations: High index of suspicion, early diagnosis, complete surgical excision of affected tissues, antibiotic therapy, maintenance of homeostasis and team work were needed for successful treatment. Intraoperative findings in one patient agree with observations of others that gastrointestinal etiology should be sought for gas gangrene of anterior abdominal wall. Recommendations are given on improvement of treatment of the lesion in affected rural areas.

Gas gangrene in pregnancy, parturition, and abortions requiring urological and surgical intervention: aetiopathogenesis, risk factors, and some current practices

“…Clostridium infections and myonecrosis may also spread centripetally from a peripheral maternal extra-uterine source to the maternal uterus and the fetal tissues. An example of the centripetal spread of clostridia infection and advancing myonecrosis was described by Sapira MK et al [43]. In that report, in a mother aged 35 years at mid-trimester of gestation, the infection spread from the maternal right hypochondrium toward the pelvis.…”

Gas gangrene in pregnancy, parturition, and abortions requiring urological and surgical intervention: Patterns, features, and world distribution

“…Our previous studies on gas gangrene in pregnancy and its outcome, and information in the literature indicated that the disease could arise from infections originating from fetal tissues, or any part of the maternal extra genital or genital tissue sites [1,2]. There has also been the notion that the disease occurs mostly in low-income countries with limited resources, and that its early features are non-specific.…”