1Puerperal SepsisMaternal Health DivisionMinistry of Health & Family WelfareGovernment of IndiaBEMoC - Presentation 6 (b)S...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Objectives Define puerpera...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India3Puerperal SepsisDefinition:...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India4How Puerperal Sepsis Occurs...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India5How Puerperal Sepsis Occurs...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India6Risk Factors for Puerperal ...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Risk Factors For Puerperal ...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Causes of Fever in Puerperi...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Causes of Fever in Puerperi...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Causes of Fever in Puerper...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India11Causes of Fever in Puerper...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India12Features of Puerperal Seps...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India13Management of Puerperal Fe...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Management of Puerperal Se...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India15Management of puerperal se...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India16Management of Puerperal Se...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India17Management of Puerperal Se...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Prevention Puerperal seps...
PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Key Messages Puerperal se...
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6b puerp sepsis 13sept2011

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6b puerp sepsis 13sept2011

  1. 1. 1Puerperal SepsisMaternal Health DivisionMinistry of Health & Family WelfareGovernment of IndiaBEMoC - Presentation 6 (b)Session 6b
  2. 2. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India2Objectives Define puerperal sepsis Acquire skills to diagnose , manage and refercases of puerperal sepsis
  3. 3. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India3Puerperal SepsisDefinition:Puerperal sepsis is an infection of the genital tract at anytime between the onset of rupture of membranes or labourand the 42nd day following delivery or abortion in which anytwo or more of the following signs and symptoms arepresent: Fever of >100.4 Fahrenheit (>38.5 ºC) Abnormal, Foul smelling vaginal discharge Lower abdominal pain Subinvoluted uterus which is tender
  4. 4. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India4How Puerperal Sepsis Occurs ? Occurs due to colonization of the genital tract bymicroorganisms Organisms can be introduced from within (infectionof endogenous origin), or from outside (infection ofexogenous origin).• Endogenous Infections: bacteria living withinvagina brought into uterus by pelvicexamination, instruments, dead tissue.Microorganisms ascend into the uterus duringpremature & PROM.• Exogenous Infections: introduced fromoutside by unclean hands, unsterileinstruments, Foreign substances & sexualactivity
  5. 5. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India5How Puerperal Sepsis Occurs ? Intrapartum:• due to PROM & can cause Chorioamnionitis Extrapartum:• may be localized or• can spread and lead to parametritis,peritonitis, septicaemia & DIC
  6. 6. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India6Risk Factors for Puerperal SepsisPatient-related Poor patient hygiene Pre-existing anaemia &malnutrition Pre-existing sexuallytransmitted infections(STIs)/RTIs Not immunized againsttetanus Pre-existing diabetesRelated to delivery Failure to follow Asepsis Frequent vaginal examinations Manipulations high in the birth canal Dead tissue in the birth canal PROM Prolonged/obstructed labour C- section/ Instrumental delivery Unrepaired vaginal/cervicallacerations PPH
  7. 7. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India7Risk Factors For Puerperal Sepsis – Contd...Related to health service delivery Delivery by untrained persons Lack of asepsis during delivery Lack of routine postpartum care Inadequate monitoring of the temperature during prolongedlabour and after delivery Non-availability of proper antibiotics Inadequate management with appropriate antibiotics in acase in whom puerperal sepsis has set in Further operative intervention in a case where puerperalsepsis has set in
  8. 8. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India8Causes of Fever in PuerperiumInfectious Localized infection of vaginal/cervical laceration orepisiotomy Infection of a laceration or episiotomy which has spreadto the underlying soft tissue Ischiorectal abscess Endometritis Salpingitis Parametritis Generalized peritonitis Septic thrombophlebitis Cystitis Acute Pyelonephritis
  9. 9. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India9Causes of Fever in Puerperium: Infectious –Contd... Tubo-ovarian abscess; Broad ligament abscess; Abscess in the pouch of Douglas Abscesses at other sites in the abdomen or chest Septicaemia Septic shock Breast infection such as mastitis or, at a later stage, breastabscess UTI Malaria Wound infection Thromboembolic disorders (superficial thrombophlebitis &DVT)
  10. 10. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India10Causes of Fever in PuerperiumNon – Infectious Dehydration Tissue trauma Reaction to foetal proteins Breast engorgement
  11. 11. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India11Causes of Fever in PuerperiumMost common causes are Endometritis Breast engorgement, mastitis, breast abscess Urinary tract infection Leg vein thrombosis Non obstetric causes
  12. 12. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India12Features of Puerperal Sepsis High grade fever Tachycardia, hypotension Excessive or foul smelling discharge Persistent lower abdominal pain On abdominal examination, uterus feels soft,tender and subinvoluted On per speculum examination, foul smellingpurulent discharge is seen which may beblood stained.
  13. 13. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India13Management of Puerperal Fever Detailed history regarding onset, severity andassociated symptoms Complete physical examination including general,systemic and local examination Manage according to the underlying cause Blood & urine for routine & microscopic investigation Encourage increased oral fluid intake Cold sponging to help decrease temperature Antibiotics Treat the cause Refer if required
  14. 14. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India14Management of Puerperal SepsisIf the general condition of the woman is non toxic i.e., lowgrade fever & pulse not rapid, give her a combination oforal antibiotics• Ampicillin 500 mg. QDS PLUS• Tab Metronidazole 400mg. TDS PLUS• Inj Gentamicin 80 mg. TDS Rule out presence of retained placental bits Monitor vitals every 2 hrly. Watch for 24 hrs If vital signs improving, then complete the course ofAntibiotic
  15. 15. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India15Management of puerperal sepsisIf fever persists after 72 hours of initiatingantibiotics: Re-evaluate and consider other causes of fever Consider if antibiotic cover sufficient; and REFER to FRU
  16. 16. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India16Management of Puerperal SepsisIf the general condition of the woman is toxic i.e.,with high grade fever & rapid pulse Start her on intravenous fluids and Give her the first dose of IV antibiotics:• Ampicillin 1 gm IV PLUS• Tab Metronidazole 500mg PLUS• Inj Gentamicin 80 mg IM Rule out presence of retained placental bits Refer the woman to FRU immediately
  17. 17. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India17Management of Puerperal Sepsis
  18. 18. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India18Prevention Puerperal sepsis is to a great extent preventable; Measures to be taken in• Antenatal Period: Improve Hb level to > 11 gms % Treat any septic focus (skin, throat etc.)• Intranatal Period: Asepsis during delivery• Postpartum Period: Maintain perineal hygiene Use of clean sanitary pad
  19. 19. PUERPERAL SEPSISMaternal Health DivisionMinistry of Health & Family WelfareGovernment of India19Key Messages Puerperal sepsis is important cause ofmaternal mortality and morbidity It is, to a great extent, preventable Early detection and treatment helps completerecovery Serious cases require referral
  20. 20. 20Thank you
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