Prevalence of Puerperal Sepsis and Associated Factors at Enugu State University of Science and Technology Teaching Hospital

Puerperal sepsis, defined as genital tract infection occurring within 42 days of delivery, is a leading direct cause of maternal death in Nigeria and a major contributor to postpartum hospital readmissions in tertiary facilities in the South East geopolitical zone. This study determines the prevalence, risk factors, causative organisms, and outcomes of puerperal sepsis at ESUT Teaching Hospital, Enugu State. A two-year retrospective review identified all puerperal sepsis cases managed on the postnatal ward from 2021 to 2022. Clinical data including mode of delivery, labour duration, antibiotic prophylaxis administration, endometritis or wound infection diagnosis, blood culture results, and clinical outcomes were extracted from case notes. Puerperal sepsis occurred in 3.4 percent of deliveries. Endometritis was the most common presentation (56 percent), followed by surgical site infection after caesarean (32 percent). Blood cultures were positive in 42 percent of systemic sepsis cases, with Escherichia coli and Staphylococcus aureus the dominant isolates. Risk factors included prolonged rupture of membranes (OR 3.1), emergency caesarean (OR 2.8), and multiple vaginal examinations in labour (OR 2.4). There was one maternal death. Recommendations include strict aseptic technique in all vaginal examinations, standardised caesarean antibiotic prophylaxis protocols, early sepsis recognition training for postnatal ward staff, and antibiogram-guided treatment at ESUT Teaching Hospital. Keywords: puerperal sepsis, endometritis, caesarean section, Enugu State, maternal infection