Complicated maternal death: puerperal sepsis in a patient with subclinical chronic disease

Maternal death is a preventable tragedy. However, in some instances, a combination of different entities might complicate the case and mislead the diagnosis. This is a case of puerperal sepsis during the early postpartum period in a previously healthy primipara due to a chronic disease that has exacerbated. The postmortem examination revealed mildly infected foci of uterine mucosa, massive hepatosplenomegaly and multiple yellow and pale patches in ventricles confirmed microscopically as myocardial infractions)with patent coronaries. Cause of death was determined as puerperal sepsis complicated with chronic anaemia. Culture-negative septicemia has been reported in chronic disease such as malignancies (eg. lymphoma, paraneoplastic syndrome) etc. Generalized sepsis may rapidly arise from miniature foci of sepsis with undiagnosed predisposing conditions. A higher degree of clinical vigilance combines with necessary investigations are essential to establish the proper diagnosis and prompt management. Thorough antenatal screening of pregnant mothers is vital irrespective of their clinical state to avoid preventable maternal deaths.