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The contribution of genital tract sepsis to maternal deaths in London
  1. E Shamil1,
  2. A Shennan1,2,
  3. S Lucas1,2
  1. 1King's College, London, UK
  2. 2St Thomas' Hospital, London, UK

Abstract

Background Genital tract sepsis (GTS) caused 4% of maternal deaths in the UK in the last Confidential Enquiry into Maternal and Child Health (2003–2005) report. A large proportion of women in London are themselves born outside the UK. Sepsis complicates a large proportion of deaths globally. The authors determined the contribution sepsis makes to maternal deaths in London.

Method Most maternal mortality autopsies in Greater London are performed in one centre (St Thomas' Hospital), using RCPath Guidelines protocol.

Information (1 January 2004 to 31 December 2009) was extracted from Autopsy Reports linked to medical notes. Premortem and autopsy blood cultures results, and full histopathology sampling was used to diagnose GTS.

Results Of 59 maternal deaths in London, 39 were direct. Of these the commonest was due to GTS (14 (36%)). The five women who died from GTS with of membrane (PROM) <24/40 gestation, were all black and deteriorated from presentation to death in 6–72 h. The other nine women were Caucasian, without any PROM. Overall only 4/14 fetuses survived. The causative pathogen was Group A Streptococci (n=6), Escherichia coli (n=3) and Streptococcus pneumoniae (n=3).

The other leading causes of direct death were eclampsia (n=6 (15%)), pulmonary thromboembolism (n=5 (13%)), post partum haemorrhage (n=5 (13%)), amniotic fluid embolism (n=4 (10%)) and thrombotic thrombocytoptnic purpura (n=3 (8%)).

Discussion GTS is the commonest cause of all maternal deaths in London, including indirect deaths. Black women only died of sepsis in association with early Preterm PROM. The higher rates of GTS in London maybe related to ethnic differences. Clinicians and Pathologists need to be aware of these higher rates of sepsis resulting in death in London.

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