Puerperal sepsis

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Puerperal sepsis

  1. 1. PRESENTED BY : MS. VRUTI PATEL, F.Y.M.SC. NURSING, SCN
  2. 2. INTRODUCTION worldwide, more than 500 000 women die of complications of pregnancy and childbirth.
  3. 3. PUERPERAL PYREXIA
  4. 4. DEFINITION A rise of temperature reaching 100.4˚F (38˚C) or more (measured orally) on separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days following delivery is called puerperal pyrexia. Puerperal fever or childbed fever in the 18th and 19th centuries affected, on average, six to 9 women in every 1,000 deliveries, killing two to three of them with peritonitis or septicemia.
  5. 5. CAUSES • PPD 0: ATELECTASIS – general anesthesia – cigarette smoking – obstructive lung disease • PPD 1-2: URINARY TRACT INFECTIONS - Multiple catheterization during labor - Multiple vaginal examinations during labor - Untreated bacteriuria
  6. 6. CONTI… • PPD 2-3: ENDOMETRITIS  Emergency cesarean section  Prolonged membrane rupture  Prolonged labor Multiple vaginal examinations during labor • PPD 4-5: WOUND INFECTION
  7. 7. CONTI… • PPD 5-6: SEPTIC PELVIC THROMBOPHLEBITIS  Emergency cesarean section  Prolonged membrane rupture  Prolonged labor  Diffuse difficult vaginal delivery • PPD 7-21: MASTITIS  Nipple trauma from breastfeeding
  8. 8. CLINICAL FINDINGS AND MANAGEMENT
  9. 9. PUERPERAL SEPSIS Definition : An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis.
  10. 10. PREDISPOSING FACTORS Antepartum factors : •Malnutrition and anaemia •Preterm labor •Premature rupture of the membrane •Chronic deliberating illness •Prolonged rupture of the membrane
  11. 11. Intrapartum factors : •Repeated vaginal examination •Prolonged rupture of the membranes •Dehydration and keto-acidosis during labor •Traumatic operative delivery •Haemorrhage - antepartum or postpartum •Retained bits of the placental tissue or membranes •Placental praevia – placental site lying close to the vagina •Caesarean delivery
  12. 12. CAUSES
  13. 13. SIGNS AND SYMPTOMS • Fever which occurs within 24 hours or more is the first sign • Increased Pulse rate • The uterus is sub-involuted, tender and softer than usual • Foul smelling vaginal discharge • Local pain and swelling of the infected suture line • Headache, insomnia and anorexia
  14. 14. In severe sepsis : •Constant pelvic pain •Rise in temperature with increased pulse rate •Lower abdominal pain •Intense pain which worsens the condition of the patients •Severe infection of the fallopian tubules •Collection of pus in the pouch of doughles
  15. 15. INVESTIGATION • History • Clinical examination • High vaginal and endocervical swabs for culture • Mid stream urine for analysis and culture • Blood for total and differential count, haemoglobinestimation • Blood culture if fever is associated with chills and rigor • Pelvic ultrasound • X-ray chest • Blood urea and electrolytes
  16. 16. PROPHYLAXIS
  17. 17. TREATMENT 1. Isolation 2. Ventilation 3. Intake 4. Proper rest 5. Mild laxatives 6. Vital signs 7. Regular bathing or sponging 8. Aseptic dressing 9. Vaginal pads 10.Antibiotics 11.Resuscitative procedures
  18. 18. SURGICAL INTERVENTION 1.Open and drain infected episiotomy 2.Clot removal or by-pass 3.Prompt and aggressive exploration and debridement of necrotic tissue 4.Hysterectomy

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