PUERPERAL

INFECTION
Infection of the reproductive tract in the postpartal 2
period is another major cause of maternal mortality.

 Risk factors for Postpartal Infections.

 1. rupture of membrane more than 24 hours before birth.
 2. retained placental fragments within the uterus
 3. postpartal hemorrhage
 4. Preexisting anemia
 5. prolonged and difficult labor particularly with instrument
births
 3

 6. Internal fetal heart monitoring electrode

 7. local vaginal infection present at the time of birth
 8. uterus explored after birth for a retained placenta or
abnormal bleeding site
 WHAT IS A PUERPERAL INFECTION?

● A puerperal infection occurs when bacteria infect the uterus and surrounding

areas after a woman gives birth. It's also known as a postpartum infection.

● It usually begins as a local infection, and potential to spread to the peritoneum

( Peritonitis ) or the circulatory system ( septicemia ) a condition that can be fatal
in a woman.

● Organism include group B streptococci, staphylococcus, and aerobic gram-

negative bacilli as Escherichia coli
● Postpartum infections consist of genital tract infections, puerperal mastitis,
pelvic thrombophlebitis, UTIs, wound infections, complications of
anesthesia, and other infectious complications.
● The management for puerperal infection is the use of appropriate antibiotic
after culture and sensitivity testing of the isolated organism.
 Assessment Findings

● 1. Temperature of 100.4 degree Fahrenheit (37.8 degree C ) or above for 2

consecutive days.
● 2. Abdominal, perineal or pelvic pain
● 3. Foul, smelling vaginal discharge
● 4. Burning sensation with urination
● 5. Chill , malaise
● 6. Rapid pulse, respiration
● 7. Elevated WBC , positive culture and sensitivity for causative organism.
 Nursing Interventions
● 1. Force fluid intake.
● 2. Administer antibiotic and other medication as ordered.
● 3. Treat symptoms as they arise. Example Hot sitz bath
● 4. Encourage high caloric diet, high protein
● 5. Position client is semi fowler’s position – to promote drainage
● 6. Support baby if isolated from mother.
 POSTPARTUM ENDOMETRITIS

• Postpartum infection of the uterus, the most common cause

of puerperal fever, is designated endomyometritis. Cesarean
delivery, particularly after labor or rupture of the membranes
of any duration, is the dominant risk factor for postpartum
endomyometritis. Endometritis infection of the endometrium
the lining of the uterus. Bacteria gain access to the uterus
through the vagina at the time of birth or during postpartal
period.
 The pathogenesis of this infection involves inoculation of
the amniotic fluid after membrane rupture or during
labor with vaginal microorganisms. The myometrium,
leaves of the broad ligament, and the peritoneal
cavity are then exposed to this contaminated fluid during
surgery.
The reported incidence of PPE after cesarean delivery is
less than 10% in patients receiving antibiotic prophylaxis.
Assessment Findings

1. Blood in the urine

2. Generalized malaise
3. Chills , constipation or diarrhea
4. Lochia –dark brown, foul odor
5. Elevation of temperature
6. Loss of appetite
7. Lower abdominal pain or low back pain
8. Irregular or heavy menstrual flow
9. Poor uterine involution
 Medical and Nursing interventions

1. Treatment consist of appropriate antibiotic

( Clindamycin ) Cleocin
2. Oxytocin agent –encourage uterine contraction. ( Methergin )
3. Requires additional fluid to combat the fever .
4. Sitting or Fowler’s position or encourage ambulation for lochia
drainage
5. Teach woman – good hand washing technique before and after
handling perineal pads.
6. Administer analgesic as ordered if strong abdominal pain is present.
Peritonitis

> infection of peritoneal cavity as an extension of endometritis.

> gravest complication of childbearing and major cause of death.
> infection spreads through the lymphatic system directly through the
fallopian tubes, uterine walls to the peritoneal cavity
ASSESSMENT:
>fever >rapid pulse
>abdominal pain >Vomiting
>abdomen is rigid but the remainder is soft
Medical and Nursing Interventions

1. To prevent vomiting and to rest the GIT , the client needs NGT.
2. Intravenous fluid or total parenteral nutrition may be necessary.
3. Administer analgesic for pain relief.
4. Administration of large doses of antibiotic to combat infection.
Wound Infection

> common type of puerperal infection, sites CS. Episiotomies,

lacerations.
Assessment Findings:
1. Tenderness
2. Redness
3. Edema
4. Warmth
5. Pain
6. Seropurulent drainage
Nursing Interventions

1. Wound infection may require hospitalization or home health care

visits.
2. Requires reassurance and supportive care.
3 Needs to teach hot sitz bath, warm compress and frequent perineal care.
4. Teach client proper way of perineal care- front to back, and change
perineal pads frequently.
5. Hand washing technique
6. adequate fluid intake and diet are important.
7. Incision and drainage of the affected area may be necessary.
8. analgesics necessary for pain
9. Broad spectrum antibiotics are ordered.
10. Infant is not routinely isolated from the mother with wound infection,
advised to protect the infant from contact with contaminated articles
like dressings.
Infection of the Perineum-from episiotomy or laceration

Assessment Findings:
1. Pain, heat and feeling of pressure
2. Inflammation of suture sites.
3. May or may not have elevated temperature
4. Stitches- one or more may sloughed away
Nursing Interventions

1. Physician may remove perineal sutures to open for drainage.

2. packing with iodoform gauze to keep it open and allow drainage.
3. Systemic or topical antibiotic may be ordered.
4. Analgesic to alleviate discomfort.
5. Sitz bath or warm compress
6. No need to restrict the woman from caring her child,
7. Hand Washing before caring her baby.
8. encourage woman to ambulate .
THROMBOPHLEBITIS

> Formation of a thrombus when a vein wall is inflamed.

>may be seen in the veins of the leg or pelvis
> may result from injury , infection or a normal increase in circulating clotting
factors during pregnancy or newly delivered woman
> occurs in postpartal period as an extension of endometrial infection

Classification : Superficial deep vein thrombosis ( SVD )

Deep vein thrombosis ( DVT )
Assessment Findings

1. pain/ discomfort in area of thrombus ( legs, pelvis and abdomen )

2. If leg pain, edema, redness over affected area
3. elevated temperature and chills
4. peripheral pulses may be decreased
5. Positive Homan’s sign-Calf pain when foot is dorsiflexed
6. if deep vein, leg may be cool and pale
7. Milk leg or phlegmasia alba dolens – leg is shiny white in appearance
Nursing Interventions

1. Maintain bed rest with leg elevated on pillow. Never raise knee gatch
on bed.
2, apply moist heat as ordered.
3. Provide bed cradle to keep sheet off the legs.
4. administer anti coagulant therapy as ordered ( Heparin ) and observe
client for signs of bleeding.
5. apply elastic support hose if needed, with daily inspection of legs
when hose is removed.
Mastitis

> infection of the breast , usually unilateral

> frequently caused by cracked nipple in nursing mother
> causative organism usually hemolytic s . Aureus
Assessment Findings:
1. elevated temperature and pulse
2. edema, tenderness or hardened area in the breast
3. maternal chills and malaise
Nursing Interventions

1. teach mother the importance of handwashing especially before and

after touching the breast
2. administer antibiotic as ordered
3. apply ice if ordered in between feedings
4. empty breast regularly