Puerperal sepsis


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puerperal sepsis and urinary tract infection

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Puerperal sepsis

  2. 2. What these following signs are indicating?    Redness
  3. 3. What are the synonymous words used for infection and post partum? Sepsis  Puerperal 
  4. 4. Infection that occurs during postpartum period is termed as?
  5. 5.          To define puerperal infection To describe the incidence and common infections To enlist the causative organism. To explain predisposing factor To discuss the mode of infection and pathology To describe the diagnostic evaluation, prevention and management To define the urinary tract infection To identify the causative organism. To explain the diagnosis and management
  6. 6.  Puerperal infection is an infection of the genital tract which occurs as a complication of delivery.
  7. 7. Puerperal infection morbidity affects 2 -10% of patient.  5 -10 times higher in caesarean delivery.  There is marked decline in puerperal infection due to: ◦ Improved obstetric care ◦ Availability of wide antibiotic
  8. 8. Endometritis  Endomyometritis  Endoparametritis 
  9. 9. Doderlein bacillus (60-70%)  Yeast like fungus –candida albicans (25%)  Staphylococcus albus or aureus  Streptococcus –anerobic common  Beta hemolyticus streptococcus rare  E.coli  Clostridium welchii 
  10. 10. Pathogenic factor for vaginal flora  the cervicovaginal mucous membrane is damage even in normal delivery and the uterine surface too,specially at the placental site it is converted into open wound by the sepration of the placenta which takes place during third stage of labor the blood clots present at the placental site are excellent media for the growth of the bacteria.
  11. 11. Malnutrition and anemia  Preterm labor  Premature rupture of membrane  Prolonged rupture of membrane 
  12. 12. Repeated vaginal examination  Traumatic operative delivery  Retained bits of placental tissue or membrane.  Placenta previa- placental site lying close to the vagina.  Hemorrhage  Caesarean delivery 
  13. 13.  Puerperal infection is an wound infection.the primary sites of the infection are:◦ ◦ ◦ ◦ Perineam Vagina Cervix Uterus
  14. 14. Perineum :Laceration of the perineum are likely to infected. The wound edges become red and swollen. There may be collection of purulent discharge resulting in complete disruption of the wound. Vagina:Vaginal laceration are infected directly or by extension from the perineal infection. The mucosa is swallon and hyperemic, resulting in necrosis and sloughing
  15. 15. Cervix:The cervical laceration become the site of infection Uterus :The uterus is most common site of infection Decidua is common site and infected first The infection usually manifests between 3rd and 6th day of delivery
  16. 16.  Putrid endometritis:- The decidua become infected and necrosed and slough off. The infection of the deeper myometrium is prevented by a zone of leukocytic barrier. The discharge become offensive Infection spread to distant site may occur when infection is sever by organism like beta hemolytic streptococci.
  17. 17.  Pelvic cellulitis:◦ Infection of the pelvic peritoneum and levator ani muscles.
  18. 18. Salpingitis: infection of the fallopian tube and overies with the formation of tubo ovarian mass Peritonitis :Lacalised pelvic abscess
  19. 19. Thrombophelebitis :Ovarian vein of one side is usually involved Uterine vein may also involved’ Septicemia and pyemia:These may lead to endocarditis, pericarditis, Renal abscess, lung abscess, meningitis or artheritis. “These are rare these days with advent of potent antibiotic”
  20. 20. Local infectionslight raise in temperature, generalised malaise and headache. Redness and the swelling of the local wound Pus formation and disruption of wound Uterine infectionPyrexia of variable degree and tachycardia. Red, copius and offensive lochia. Subinvoluted, tender and soft uterus.
  21. 21. Sever infectionFever with chills and rigor Rapid pulse Scanty, odorless lochia Involuted uterus  ParemetritisSustained rise in temperature (7th to 10th day) Constant pelvic pain Tenderness on either side of the hypogastrium Unilateral, tender mass felt on vaginal examination leukocytosis 
  22. 22. Pelvic peritonitis:Pyrexia with increased pulse rate Lower abdominal pain and tenderness Collection of the pus in pouch of douglas 
  23. 23. Generalised peritonitis:High fever with rapid pulse Vomiting Abdominal pain Tender and distended abdomen  Thrombophelebitis – swinging fever with chills and rigor Features of pyemia 
  24. 24. SepticemiaHigh temperature with rigor Rapid pulse Headache, insomnia or mental confusion Positive blood culture Sign/symptoms of infection in the lungs, meninges or joint 
  25. 25. Bacteriological studySmear Culture and antibiotic sensitivity of purulent material High vaginal and cervial swabs Peritoneal fluids Blood culture 
  26. 26. Urine :Routine and microscopic examination Culture if infection is suspected   Complete blood count-
  27. 27. UltrasonographyFor diagnosis of pelvic masses Pelvic abscess Pelvic peritonitis Retained bits of placenta and/ or membrane
  28. 28.  Other specific investigation X – ray Blood for malaria parasite
  29. 29.  Antenatal  Improvement of general condition  Treatment of septic cocci  Abstinence from sexual intercourse in the last two months  Care about personal hygiene – bathing in dirty water to be avoided  Avoiding contact with people having infection, such as cold, boils.  Avoiding unnecessary vaginal examinations and douches in the later months.
  30. 30. Intrapartum  Staff attending on labor client should be free of infections.   Full surgical asepsis to be taken while conducting delivery  Women having respiratory tract infection or skin infection should be admitted in single room or separate ward  Membranes should be kept intact as long as possible and vaginal examination should be restricted to minimum
  31. 31.  Traumatic vaginal delivery and intrauterine manipulation should be preferably avoided. If required , should be done using fresh (sterile) gloves with liberal use of strong antiseptic solution.  Laceration of the genital tract should be repaired promptly and meticulously with perfect homeostasis  Excessive blood loss during delivery should be replaced promptly by transfusion to improve the general body resistance  Prophylactic antibiotic must be administered in cases of premature rupture of membranes, prolonged labor or following traumatic delivery.
  32. 32.  Postpartum  Take aseptic precautions while dressing the perineal wound  Restriction of the visitor in the postpartum ward  Mothers to be instructed to use sterile sanitary pads and to change them frequently  Vulva and perineum to be cleaned with mild antiseptic solution following urination and defecation  Infected mothers and babies are to be isolated  To keep the floor of the in – patient ward dust free by frequent mopping.
  33. 33.  The woman should be placed in sterile room/ward with adequate light and ventilation  Complete rest is to be given in head high position which help in drainage of lochia and localization of infection to the pelvis if there is pelvic peritonitis  Analgesics and sedatives are administered to enforce rest
  34. 34. Treatment cont…     Broad spectrum antibiotics are given IV until antibiotic sensitivity report are available, followed by specific antibiotics. Stool softeners are administered to keep the keep the bowel open Anemia to be corrected by blood transfusion Infected wound of perineum valva and vagina are laid open for drainage, cleaned and dressed with antiseptic preparation.
  35. 35. Surgical treatment The stitches of the perineal wound may have to be removed to facilitate drainage of pus and relieve pain. After the infection is controlled, secondary sutures may be given later.  Infected retained product should be removed as early as possible under cover of antibiotics . Pelvic abscess should be drained by colpotomy  Abscess above the poupart’s ligaments should be incised and the pus drained. 
  36. 36. It is an infection of the urinary organs such as kidney, ureter, urinary bladder and urethra.
  37. 37. E. coli  Klebsiella  Proteus  Staphylococcus aureus 
  38. 38. Other causes are:Recurrence of previous cystitis and pyelitis  Infection contracted for the first time during pregnancy is due to : Effect of frequent catheterization either during  labor or in early puerperium to relative retention of urine.  Stasis of urine during early puerperium due to lack of bladder tone and less desire to pass urine.
  39. 39.  It is one of the common cause of puesperal pyrexia, the incidence being 1- 5 % of all deliveries.
  40. 40. Raised temperature ( pyrexia)  Costovertebral angle pain  Supra pubic discomfort  Frequent and often painful micturation  Nausea and vomiting 
  41. 41.  UTI is confirmed by examination of an uncontaminated midstream clean catch sample for urinalysis and culture and antibiotic sensitivity test.
  42. 42.  High fluid intake  Adequate drainage of urine  Appropriate antimicrobial therapy.