PUERPRAL SEPSIS.

 It is an infection in the genital tract following childbirth.

 It is an infection of the female reproductive tract following childbirth or
abortion.
 It is also known as postpartum infection, it normally occurs after 24hours
following childbirth.
 It is caused by the streptococcal bacteria, mostly streptococcus pyogens,
staphylococcus aureus and coliform bacteria.
 The perineum, vagina, cervix and uterus are the main sites of infection.
 Puerpral sepsis is one of the major causes of maternal death if it goes
undetected and untreated.

ROUTES OF INFECTION AND CAUSATIVE ORGANISM

It is classified under endogenous and exogenous.

 Endogenous : where the are already present in or on the body. Eg
streptococcus faecalis(lives in the anus and perineum), clostridium welchii
(present in the vagina), or Escherichia coli (present in the bowel).
 Exogenous : from external contamination where the organisms are
transferred from other people, body surfaces or environment. Eg.
Chlamydia trachomatis and nosocomial infections.
NB: Staphylococcus is the most frequent cause of wound infection, breast
infection and has resistance to antibiotics commonly found in dust.

PREDISPOSING CAUSES OF PUERPRAL SEPSIS

 Pregnancy
 Malnutrition or anaemia
 Sexually transmitted diseases eg. Syphilis
 Early rupture of membranes.
  Labour
 Untreated cuts or wounds in vagina- which may become infected.
 Caesarian section increases the chance of developing puerpral sepsis.
 Home delivery under unhygienic condition.
 Retained product of conception
 Prolonged ruptured of membranes
 Prolong labour
 Multiple/ repeated vaginal examination

 Puerperium
 Postpartum hemorrhage
 Low socioeconomic status
 Early sexual activity
 Poor vulva hygiene

CLINICAL MANIFESTATION OF PUERPRAL SEPSIS.

 Pyrexia of 38°c or more which persist for 24hrs or more
 Rapid thready pulse
 Low blood pressure
 Tender uterus on palpation
 Offensive lochia
 Subinvolution of the uterus
 General malaise
 Nausea and vomiting

INVESTIGATIONS
 High vaginal swab as high
 Midstream specimen urine.
 Hb go rule out anaemia
 Grouping and cross matching for possible blood transfusion
 Clothing profile
 Ultrasound scan to rule out retained product of conception.
MANAGEMENT OF PUERPRAL SEPSIS
Same as management for puerpral pyrexia ….plus the following
points
1. If patient is in septic shock or having evidence of severe sepsis,
resuscitative procedure should be instituted without delay
2. Encourage client to change perineal pad frequently to prevent
further infection
3. Uterine infection, treat with broad spectrum antibiotics
4. Infected episiotomies can be opened and allowed to drain, or in
abscess formation, it should be incised and drained.

COMPLICATIONS OF PUERPRAL SEPSIS

 Septicemia: a condition in wh bacteria gets into the
bloodstream and cause dangerous inflammation.
 Septic shock
 Renal failure
 Adhesions of the reproductive organs
 Pulmonary embolism
 Peritonitis or abscess formation leading to surgery and
compromised future fertility.
 Pelvic thrombophlebitis: blood clots in the pelvic veins.
 Death

PREVENTION OF PUERPRAL SEPSIS

ANTENATAL
 Maintain a healthy heamoglobin level, preferably above
11g/dl.
 Intake of iron,vitamins and protein supplements to prevent
anaemia and build up the immune system.
 Encourage intake of enough water to flush the system of
toxins.
  Regular antenatal visit and reporting of any danger signs in
pregnancy to the hospital on time.
 Early treatment of infections such as flu
 Immunizations e.g tetanus diphtheria.

LABOUR
 Avoidance of unnecessary vaginal examination.
 Proper hand washing technique.
 Using of aseptic technique in every procedure performed.
 Monitor vital parameters such as pulse, body temperature etc.
 Using of partograph to monitor labour to prevent prolong labour.
 Strict adherence to sterile procedure at every vaginal examination in
women in labour.
 Ensuring sterility in the labour room and theatre room
 Encouragement of voiding during labour to prevent unnecessary
catheterization.
 Avoid unnecessary episiotomy
 Proper disinfection technique and correct sterilization.
 Consider antibiotics as prophylaxis for invasive procedures like manual
removal of placenta, internal version, third degree tear.
 Give antibiotics to mother’s with early rupture of membranes 6hours
before onset of labour/full dilation.
 Vulva hygiene and avoid re-application of fallen perineal pad
 Usage of prepacked sterilized delivery kit
 Avoid premature rupture of membranes
 Staff with respiratory tract infection should be off duty
 Ensure swab count before closing the skin in c/s
 Perineal wounds should be cleaned and sutured as soon as possible after
delivery.
 PUERPERIUM
 Maintain proper hygiene especially around perineum, keeping it dry and
clean.
 Frequent changing of perineal pad and applying new one.
 Hand washing before and after visiting the toilet
 Good personal and vulva hygiene
 Avoid inserting fingers and herbs into the vagina
 Intake of adequate nutritious diet to build the immune system.
 All blood losses and completeness of placenta should be recorded at all
deliveries.
 Early ambulation after delivery to protect against venous thrombosis
 New mother’s should be taught how to fix baby to breast to reduce risk of
mastitis.