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Puerperal Infection
- 1. MS.SASIKALA.N MSC (N),OBSTETRICS AND GYNECOLOGICAL NURSING LECTURER GANGA COLLEGE OF NURSING COIMBATORE
- 3. Objectives • Define Puerperal Infection • Enumerate the causes and predisposing factors • List out the Mode of Infection • Describe the Pathophysiology • Discuss the Clinical features • Explain the Management of Puerperal Infection
- 4. Introduction • Puerperal infection is an infection developing in the birth structure after delivery. • Puerperal infection is a major cause of Maternal Morbidity and Mortality.
- 5. Definition – Puerperal Infection • A puerperal infection occurs when bacteria infect the uterus and surrounding areas after a women gives birth. • It is also known as Postpartum Infection.
- 6. Puerperal Fever-define • A rise of Temperature reaching 100.4 ̊ F(38 ̊C) or more (measured orally) on 2 separate occasions at 24 hours apart(excluding first 24 hours)within first 10 days following delivery. Also known as Childbed Fever/Puerperal Fever.
- 8. Define • According to WHO, Puerperal Sepsis is defined as the Infection of the Genital tract occurring at labour or within 42days of the Postpartum period. • Dc Dutta, an Infection of the Genital tract which occurs as a complication of Delivery or Miscarriage is termed as Puerperal Sepsis. • It is also known as Childbed Fever/Childbirth Fever.
- 9. Difference between Puerperal sepsis • An infection of the genital tract which occurs as a complication of delivery or miscarriage within 6 weeks is termed as puerperal sepsis. Reproductive tract infection • Infection of external and /or internal Reproductive organs.
- 10. Causes • Endometritis • Endomyometritis • Endoparameritis • Or combination of all these(pelvic cellulitis)
- 11. Predisposing Factors Malnutrition Preterm Labour Premature ROM Prolonged ROM
- 12. Intrapartum APH/PPH Retained bits of placenta Traumatic operative delivery Repeated PV
- 13. Causative Micro Organism • Streptococcus Haemolytic group A(GAS) • Streptococcus Haemolyticus group B(GBS) • Staphylococcus Pyogens • E.coli • Streptococcus • Peptococcus • Bacteriodes
- 14. Mode of infection Exogenous organism The causative organism are, • Streptococcus Fecalis that lives in the anus and in the Perineum. Anaerobic Streptococci and Clostridium Welchi which are found in the vagina. • These are responsible for the Infection. Endogenous organism • This comes from sources outside the body and are transmitted by another person • The source of infection can be Midwife,Doctor and other patient or visitors. • Air and dust also cause infection to the patient.
- 15. Pathophysiology Primary site of infection – Perineum, Vagina,Cervix & Uterus. Endometrium (placental infection site),Lacerated wound of the Perineum, Vagina & cervix are favourable sites for bacterial growth &multiplication (group A or group B Streptococci, Clostridia) Devitalised tissue, Blood clots, Foreign body(Retained cotton swab) & Surgical trauma(C.S) Favour microbial growth, Proliferation & Spread of infection Spread to distant site i.e uterus(placental implantation site) Endometritis, parametritis & cellulitis) Localised infection, laceration of the perineum, vagina & cervix. or
- 17. Spread of infection Pelvic cellulitis • Infection of the pelvic peritoneum and levator ani muscles.
- 18. Salphingitis: Infection of the fallopian tube and ovaries with the formation of tubo- ovarian abcess Peritonitis: Localised pelvic abscess
- 19. Cont.. Pelvic cellulitis Pelvic thrombophlebitis Septicaemia and septic shock
- 20. Clinical features Local infection : • Slight rise of temperature • Generalised malaise or headache • Wound becomes red & swollen • Pus formation • If becomes severe temperature with chills & rigor. • Sero purulent discharge
- 21. Cont… Uterine Infection : • Mild – Rise in Temperature(>100 degree) • Rise in Pulse rate >90b/min • Lochia becomes Offensive and Copious. • Subinvolution and tender (may be due to Lochiastasis and Lochiometra)
- 22. Cont… Severe : • High rise of temperature • Chills and Rigor • Rapid Pulse Rate • Breathlessness • Abdominal pain • Dysuria • Lochorrhea – green in colour and foul smelling • Uterus may be Subinvoluted and tender
- 23. Cont.. Extra Uterine spread • Presence of pelvic tenderness(pelvic peritonitis) • Tenderness on the fornix(parametritis)bulging fluctuant mass in the pouch of Douglas(pelvic abscess).
- 25. Clean catch mid stream urine – culture sensitivity High vaginal & Endocervical swab- Culture & sensitivity Thick blood film – Malarial parasite Pelvic USG – Placental bits History - h/o any high risk factor for Infection like anemia,PROM or Prolonged labour Blood culture Blood test – DC,TC & Hb Clinical Examination- Abdomen & Pelvic examination to check involution & examine leg for thrombophlebitis Colour Doppler- Venous thrombosis CT & MRI – Lung Pathology, T.BBlood urea and Electolytes Diagnosis
- 26. Prevention Antenatal period • Diagnosis and treatment of UTI, Anaemia and Malnutrition & Diabetes Mellitus • Assessment of risk factors for Feto pelvic disproportion. • Diagnosis and treatment of pre existing sexually transmitted infections e.g. Gonorrhoea, Chlamydia etc. and other infections • Identification and appropriate management of prolonged rupture of membranes(>12hours)
- 27. Cont.. Intranatal period • Full surgical asepsis during delivery. • Screening for group B streptococcus in high risk cases • Prophylactic Antibiotics in C.S • Postnatal period • Aseptic precaution • Restrict visitors
- 28. Treatment General care • Isolate infected baby & mother when the culture shows Haemolytic streptococci infection • Adequate Fluid Calorie through IV • Urinary catheterisation for urine retention • Maintain chart-TPR, IO chart & Lochia discharge
- 29. Cont.. It depends on c/s • Gentamicin(2mg/kg IV loading dose following 1.5mg/kg every 8 hours) • Ampicillin (1gm IV every 6 hours) • Clindamycin(900mg IV every 8 hours) • Cefotoxime 1gm, every 8 hours • Metronidazole 0.5mg IV every 8 hours. • It should be continued for about 7 – 10 days
- 30. Surgical treatment • Removal of perineal sutures for easy drainage. clean wound with sitz bath & do dressing with antiseptic ointment. secondary suture after wound infection controlled • Remove retained uterine products • Drain pelvic abscess by Colpotomy • Clean wound dehiscence of episiotomy & C.S remove necrotic tissue & restore it. • Hysterectomy in case of rupture or Perforation,gangereneous uterus or multiple abscess.