Academic journal article Journal of Health Population and Nutrition

Incidence of Postpartum Infection after Vaginal Delivery in Viet Nam

Academic journal article Journal of Health Population and Nutrition

Incidence of Postpartum Infection after Vaginal Delivery in Viet Nam

Article excerpt

INTRODUCTION

Almost all (99%) maternal mortality occurs in developing countries (1). The World Health Organization (WHO) claims infection to be the primary cause of 15% of maternal mortality (2). However, as a secondary or undetected primary cause, infection may account for a portion of the maternal mortality attributed to haemorrhage (25%), unsafe abortion (13%), and other direct and indirect causes (27%). This may explain why a meta-analysis of developing-country data found infection accounted for a substantially-higher proportion of maternal mortality contributing nearly 30% of the direct causes of maternal mortality (3). From this perspective, just preventing or treating infection in developing countries could greatly reduce mater-nal mortality.

Historical patterns of maternal mortality in Western Europe and the United States also suggest that infection contributed to a much larger proportion of obstetric morbidity and mortality than that currently attributed to infection (4). Before 1937, puerperal fever was the single greatest cause of maternal mortality in England and Wales, where a 20% decline in maternal mortality rate (MMR), from 1880 to 1920, is attributed to the increased use of aseptic techniques and reduction of unnecessary interference, both of which reduce maternal infection (4).

Sixty percent of maternal deaths occur in the postpartum period (2). Yet, in developing countries, care after delivery is uncommon and generally sought for the newborn rather than for the mother; therefore, postpartum infection is rarely observed or clinically measured and may be greatly underestimated (3,5). In the very few countries where receipt of postpartum care is reported at all, only 30% of women receive postpartum care (6). In developing countries, postpartum infection is usually assessed by self-reported symptoms, and its contribution to maternal deaths is usually evaluated by 'verbal autopsy' (7) (a history of events as recalled by those with the woman at the time of her delivery and death), because nearly 50% of births and a greater proportion of maternal deaths occur at home (6). These estimates of postpartum infection are very inaccurate (8-13). Hence, this study was designed to assess the incidence of serious and non-serious postpartum infections in two hospitals in Viet Nam to determine whether postpartum infection is underestimated. We conducted a prospective study in Viet Nam, where 70% of women deliver institutionally (6), in an urban (Hung Vuong Hospital) and semi-rural, peripheral (Cu Chi Hospital) setting in Ho Chi Minh City where the quality of obstetric care permits accurate diagnosis and careful measurement of non-surgical postpartum infection.

The objective of the study was to assess the incidence of postpartum infection in settings where infection can be accurately identified and where its incidence is likely much lower than that in women delivering in less hygienic circumstances, at home or in clinics, where most maternal mortality occurs (14), to judge whether postpartum infection is underestimated.

We assumed the rate of serious obstetric infection not associated with surgical intervention in Viet Nam might be similar to that observed in a British study conducted in 1929 (15). We considered the 1929 British environment to be similar to the present-day Viet Nam environment in the sense that aseptic techniques are used for preventing infection but socioeconomic conditions and nutritional status are less than ideal. We also hypothesized that the incidence of puerperal and postpartum infections would be four times greater than serious obstetric infection, perhaps similar to that observed in post-caesarean patients in Hung Vuong (9%), assuming that the rate was largely underestimated. The hypothesized incidence of postpartum infection and serious postpartum infection is, respectively, 50 and 20 times greater than the 1999 reported rate of postpartum infection in Ho Chi Minh City (0. …

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