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Purperalinfections
Purperalinfections
,
LECTURER,
OBSTETRICS AND GYNECOLOGICAL NURSING
GANGA INSTITUTE OF HEALTH SCIENCES,
COIMBATORE.
PUERPERAL INFECTION
• Puerperal infection (also known as childbed fever) is a
disease that occurs shortly after childbirth.
• It is a leading cause of maternal death, accounting for
up to 16% of cases of mortality.
• It causes at least 75,000 maternal deaths worldwide per
year, most of which occur in developing countries.
Postpartum urinary retention occurs in 10-15 % of
women (Yip et al. 1998; Lee et al. 1999)
• “Puerperium is the period following the child birth
from 2-4mm.
• The superficial part containing the degenerated
6weeks.
• Puerperal infections is a term used to describe any
infections of the reproductive tract during the first six
weeks of postpartum.
Definition
• Puerperal infection/ puerperal pyrexia is a
bacterial infection that occurs following childbirth.
The diagnostic criteria require that the childbearing
woman have a temperature elevated over 100.4°F
(38°C) on any two of the first 10 post-partum days
after day one, or over 101.5°F (38.6°C) during the
first 24 hours.
Causes
The causes of pyrexia are;
• Puerperal sepsis
• Urinary tract infection
• Mastitis
• Infection of caesarean wound
• Pulmonary infection
• Septic pelvic thrombophlebitis
• Malaria or pulmonary tuberculosis
• Unknown origin
Organisms
– Nutritional status
– Obesity
Predisposing Factors
• preterm labor
• premature rupture of membrane
• Vagina
• Cervix
• Uterus
• The infection is either localized to the site or spread
to distant sites.
• The lacerations on the perineum, vagina and cervix
are often infected by the organism due to the presence
• Local infection
• Uterine infection
• Spreading infection
INVESTIGATIONS OF PUERPERAL
SEPSIS
• History
• Clinical examination: includes the study of pulse and
temperature chart, neck stiffness
• systematic examination includes breast, lungs, heart,
liver, spleen and legs
• abdominal examinations to note involution of the
uterus, whether the uterus is tender or not, presence
of peritonitis or pelvic abscess
• internal examination to note the character of lochia,
or abscess,
• limbs are examined to detect thrombophlebitis or
thrombosis.
• High vaginal an endocervical swabs for culture in
aerobic and anaerobic media and sensitivity test to
antibiotics
• Clean catch midstream specimen of urine for analysis
and culture including sensitivity test
• Blood for total and differential white cell count,
haemoglobin estimation.
• Thick blood film should be examined for malaria
parasite.
• Pelvic ultrasound to detect any retained bits of
conception within the uterus,
• color flow Doppler study to detect venous thrombosis
• C T and MRI
• X-ray chest to know the lung pathology
• Blood urea and electrolytes to know the renal
pathology
PROPHYLAXIS
Antenatal prophylaxis:
• improvement of nutritional status
Antibiotics:
• Gentamycin 2mg/kg IV loading dose followed by 1.5mg/kg
IV every 8 hrs and ampicillin 1gm IV every 6 hrs
• clindamycin 900 mg IV every 8 hrs should be started.
Intravenous administration of cefotaxime 1gm 8 hrly is
• Metronidazole 0.5gm IV is given at 8 hours interval
to control the anaerobic group.
• The treatment is continued until the infection is
controlled at least 7-10 days.
Surgical treatment:
Perineal wound:
• the stitches the perineal wound may have to be
removed
• The wound is to be dressed with hot compress with
mild antiseptic solution followed by application of
antiseptic ointment or powder.
• After the infection is controlled, secondary suture
may be given at a later date.
• Retained uterine product: Surgical evacuation after
is indicated
• Hysterectomy in case with rupture or perforation,
• infection control
UTERINE
SUBINVOLUTION
• Subinvolution is a medical condition in which after
childbirth, the uterus does not return to its normal
size.
• Definition: When the involution is impaired or
retarded it is called subinvolution
• The uterus is the most common organ affected by
subinvolution.
• As it is the most accessible organ to be measured per
abdomen ,the uterine involution is considered
clinically as an index to assess subinvolution.
• Uterine subinvolution is a slowing of the process of
involution or shrinking of the uterus.
Causes
Predisposing factors are
A. Grand multiparty
B. Over distension of uterus as in twins and hydramnios
C. Maternal ill health
D. Caesarean section
E. Pelvic infection
E. Prolapse of the uterus
G. Uterine fibroid
Aggravating factors are:
• Retained products of conception
• Uterine sepsis
• Endometritis
Symptoms
The condition may be asymptomatic. The predominant
symptoms are:
Abnormal lochial discharge either excessive or
prolonged
Irregular or at times excessive uterine bleeding
Irregular cramp like pain is cases of retained products
or rise of temperature in sepsis
Signs
(b) Pitocin.
(c) Ergotrate.
(2) Dilation and curettage (D&C) to remove any
placental fragments.
Contraindications
headache.
(e.g., eclampsia).
eclampsia, diabetes).27
Other uses: This drug may also be used during
after childbirth.
• Secondary
PRIMARY POSTPARTUM
HAEMORRHAGE
Two types
Four causes;
• Atonic
• Traumatic
• Mixed
• Blood coagulopathy
Atonic
• Grand multipara: inadequate retraction and frequent
adherent placenta
• Over distension of the uterus
• Malnutrition and anaemia
• Antepartum haemorrhage
• Prolonged labour
• Anaesthesia
• Initiation or augmentation of delivery by oxytocin
• Persistent uterine distension: retention of partially
separated placenta or bits of placenta or blood clots
• Malformation of uterus
• Uterine fibroid
• Constriction ring
• Precipitate labour: in rapid delivery
Mismanaged third stage of labour
• Too rapid delivery of the baby
• Premature attempt to deliver the placenta before it is
separated
• Kneading and fiddling of the uterus
delivery of placenta
• Shock
• Infection
• Inversion
• Sub involution
• Thrombo phlebitis
• Embolism
MANAGEMENT OF TRUE
POSTPARTUM HAEMORRHAGE
under GA.
• Procedure: a 5 meter long strip of gauze, 8cm wide
before introduction.
• The gauze is high up and packed in to fundal area
Traumatic PPH
• The trauma to the perineum, vagina and cervix is to
be searched under good light by speculum
examination and haemostasis is achieved by catgut
sutures.
SECONDARY POSTPARTUM HAEMORRHAGE
Causes
• The bleeding occurs between 8th to 14th days of delivery.
haemorrhage