Puerperal Sepsis

 Diagnosed when the patient’s temp. is higher

than 38˚c on 2 separate occassions atleast 24
hrs. Apart, following the first 24 hrs. Delivery.
 Most commonly encountered within the first 2
weeks after delivery, but the definition is
applied until 42 days postpartum.
 Risk Factors
 Preterm & prolonged ROM
 Prolonged labour
 Obstetric trauma
 Multiple PVs
 Operative delivery
 Immune suppression
 Low economic status
 Low serum albumin
 Sites of puerperal infection

 Endometrium
 Pelvis
 RTI, UTI, wound, veins, breasts & other
infections- systemic infection, bacterial
endocarditis
Bacteriology
Β-haemolytic streptococci
Streptococci
Staphylococci
Peptococci
Peptostreptococci
Klebsiella
Bacteroid species
 Complications
 Local spread to parametria ( parametritis )
 Peritonitis
 Pelvic abscess
 Pelvic thrombophlebitis
 Septic shock
 Severe infection leading to permanent tubal
damage
 Septic Shock
 Pathophsiology – 3 phases
 1. Warm hypotensive phase
 2. Cold hypotensive phase
 3. Secondary shock
 Management
 1. Resuscitation
 2. Monitoring
 3. Medication
 4. Surgery
 Development of septic shock

 Primary – Infection without endotoxin

 Secondary – Infection with endotoxin

 Tertiary – poor or no response

Clinical features
 Symptoms- LAP, foul smelling lochia
Generalised symptoms- fever, malaise, palpitations
 Signs- Classical Triad: Tachycardia, tachypnoea
CET
GE: Pyrexia, tachycardia, tachypnoea & hypotension if
in shock
Suprapubic or uterine tenderness-uterus abnormally
soft, subinvolution of uterus ,
may be ileus,
Cx- CET, os usually open
 Management
 Investigations- FBC, U&E, blood culture, urine
M.C.&S
Sonar, & additional investigations like blood
gases, chest X-ray etc. as indicated
 Broad spectrum antibiotics
Triple AB – ampicillin, gentamycin, flagyl
Scale up as necessary
 Heparin or clexane ( pelvic thrombophlebitis-low
grade fever)
 Indications of hysterectomy- poor or no response
to treatment, ileus, pelvic abscess, septic shock
 PREVENTION OF SEPTIC SHOCK
 Meticulous asepsis in obs.
 Early diagnosis of puerperal infection with
prompt management
 Risk assessment with adequate prophylaxis &
indications of antibiotic prophylaxis
-C/S
-Obstetric trauma
-PTROM
-RPOC
 General well being of the patient – correction of
anaemia, & management of other infections
 Referral Framework
 Primary care – Puerperal sepsis without shock

 Secondary care – Puerperal sepsis not or poorly

responding to treatment, severe degrees of
puerperal sepsis, early phases of septic shock

 Tertiary care – Late phases of septic shock: 3 or

more organs affected, stupor / coma, DIC,
jaundice