Puerperal sepsis is defined as a genital tract infection occurring during or within 42 days of delivery or miscarriage. It is most commonly caused by bacteria that are part of the normal vaginal flora. Risk factors include anemia, preterm labor, prolonged labor, and diabetes. Symptoms include fever, abnormal vaginal discharge, and pelvic or abdominal pain. Diagnosis involves cultures of vaginal secretions and blood, and imaging tests can identify any abscesses. Treatment consists of antibiotics based on culture results as well as wound and surgical care if needed. Prevention focuses on proper hygiene, nutrition, and early treatment of potential infections.
2. What is puerperium?
• It is the period of about six weeks after child birth
during which the mother’s reproductive organs return
back to their original non-pregnant condition.
What is sepsis?
• The presence of tissue of harmful bacteria and their
toxins, through infection of a wound
3. According to (World Health Organization) WHO puerperal sepsis is defines as
the infection of the genital tract occurring at labour or within 42 days of the
postpartum period.
OR
An infection of the genital tract which occurs as a complication of delivery or
miscarriage is termed as puerperal sepsis.
The primary site of infection are:-
1. Perineum
2. Vagina
3. Cervix
4. uterus
11. • Rise in temperature
• Pus formation
• Local wound becomes red and
swollen PRISH (pain, redness,
immobility, swelling, heat.
• Rise in temperature (>100.4 F)
• Rise in pulse rate >90 b/m
• Lochial discharge become offensive
and copious.
1. Local infection 2. Uterine infection
12. 3. Spreading infection (extrauterine spread)
• Parametritis (the inflamma
tion of the parametrium,
the connective tissue of
the pelvic floor)
Constant pelvic pain
Tenderness
Rise in temperature with
chills.
Pelvic peritonitis
Pyrexia with increase in
pulse rate.
Lower abdominal pain
and tenderness and
collection of pus.
13. General principle in investigations are:-
To locate the site of infection.
To identify the organism
To assess the severity of the diseases.
14. • Antenatal, Intranatal and Postnatal
history of any high risk factors for
infection like anemia, prolonged
labour and PROM.
15. Thorough general, physical and systematic
examination, abdominal examination are done
to locate specific site of infection.
16. High vaginal and endocervical swabs for culture in ae
robic and anaerobic media and sensitivity test for
antibiotics.
Blood culture if fever is associated with chills.
Pelvic ultrasound to detect any retained bits of
conception within the uterus, to locate any abscess
within the pelvis
17. • Antibiotics: Ideal antibiotic regimen should depend on the culture
and sensitivity report.
• Gentamicin (1.5mg/kg/8 hourly) + Clindamycin (900mg/8 hourly)
• Metronidazole (500mg/12 hr)+ Penicillin (5 million units/6 hr)
• Ampicillin (2gm/6hr) + gentamycin
18.
19. Stiches of the perineal wound..
Surgical evacuation
20.
21.
22. • Isolation of the patient
• Adequate fluid and calorie.
• Ensure the wound is cleaned with sitz bath several times a day and is dressed
with an antiseptic ointment.
• Demonstrate and encourage correct perineal cleaning after voiding and defec
-ation and frequent changing of the perineal pads.
• Demonstrate proper fundal massage.
• Monitor temperature, pulse and respiration
• Change client’s position frequently. Provide comfort measures. eg. back rub.
• Administer antibiotics as prescribed.
