Causes and risk factors
Obstetric tetanus can be caused due to use of unsterile obstetric instruments. After delivery, patient’s genital tract has large bare surface area which can become infected. It enters the body through open or unhealed wounds at the time of delivery. A poison known as tetanospasmin is released by the bacteria. This poison is responsible for blocking nerve signals from brain to muscles thus resulting in muscle spasms, sometimes so severe that they can even tear the muscles. Lack of sterile and antiseptic precautions at the time of delivery, inadequately vaccinated or non- immunised mother during pregnancy, home deliveries, people from poor socioeconomic strata, inadequate health facilities for safe deliveries in poor or developing countries are the major risk factors for obstetric tetanus.
Clinical presentation
Patient presents with high fever. Signs and symptoms occur like mild spasm affecting jaw muscles called as lockjaw. as well as chest, neck, back, and abdominal muscles spasms and muscle rigidity. Severe spasms can involve the back, causing arching of back and called as ophisthotonos. When spasms affect the muscles of respiration, it leads to dyspnoea [difficulty in breathing]. Prolonged muscle spasms with sudden severe painful contractions is called as tetani. This condition is so severe that it can lead to fracture and muscle tears. Additional symptoms include excessive drooling of saliva, irritability, and difficulty in swallowing [dysphagia].
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Routine blood examination is done. Urine analysis is recommended.
Treatment
Treatment involves administration of antibiotics. Tetanus anti toxin [TT] is administered along with tetanus immune globulin [TIG]. Muscle relaxants and sedatives to reduce spasms may be given. Breathing is supported with oxygen and breathing machine. Recent management includes neuromuscular blockade and positive pressure ventilation with tracheotomy. There is a high risk of the newborn getting infected from the mother. Prevention is necessary which is possible by immunisation. It includes active immunisation of mother which includes 2 monthly injections of tetanus toxoid [TT]. Administration of TT 4 to 6 weeks prior to delivery stimulates antitoxin that protects the mother and crosses placenta, thereby protecting the foetus. Booster dose of TT is necessary after delivery. If mother has not received tetanus toxoid during pregnancy, a dose of human tetanus immunoglobulin [TIG] will prevent obstetric tetanus post delivery.
Other Modes of treatment
The other modes of treatment can also be effective in treating obstetric tetanus. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are is also found to be effective in treating obstetric tetanus.
