M.Sc NURSING Ist year
What these following signs are
What are the synonymous words
used for infection and post partum?
Infection that occurs during
postpartum period is termed as?
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
To define the urinary tract infection
To identify the causative organism.
To explain the diagnosis and management
Puerperal infection is an infection of the
genital tract which occurs as a complication
Puerperal infection morbidity affects 2 -10%
5 -10 times higher in caesarean
There is marked decline in puerperal
infection due to:
◦ Improved obstetric care
◦ Availability of wide antibiotic
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
the blood clots present at the placental site are
excellent media for the growth of the bacteria.
Malnutrition and anemia
Premature rupture of membrane
Prolonged rupture of membrane
Repeated vaginal examination
Traumatic operative delivery
Retained bits of placental tissue or membrane.
Placenta previa- placental site lying close to the
infection.the primary sites of the infection
of the perineum are likely to
The wound edges become red and swollen.
There may be collection of purulent discharge
resulting in complete disruption of the
laceration are infected directly or by
extension from the perineal infection.
The mucosa is swallon and hyperemic,
resulting in necrosis and sloughing
cervical laceration become the site of
uterus is most common site of
Decidua is common site and infected first
The infection usually manifests between 3rd
and 6th day of delivery
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
Pelvic cellulitis:◦ Infection of the pelvic peritoneum and levator
Salpingitis: infection of the fallopian tube and overies
with the formation of tubo ovarian mass
Peritonitis :Lacalised pelvic abscess
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
“These are rare these days with advent
of potent antibiotic”
Local infectionslight raise in temperature, generalised
malaise and headache.
Redness and the swelling of the local wound
Pus formation and disruption of wound
Uterine infectionPyrexia of variable degree and tachycardia.
Red, copius and offensive lochia.
Subinvoluted, tender and soft uterus.
Sever infectionFever with chills and rigor
Scanty, odorless lochia
ParemetritisSustained rise in temperature (7th to 10th day)
Constant pelvic pain
Tenderness on either side of the hypogastrium
Unilateral, tender mass felt on vaginal
Pelvic peritonitis:Pyrexia with increased pulse rate
Lower abdominal pain and tenderness
Collection of the pus in pouch of douglas
Generalised peritonitis:High fever with rapid pulse
Tender and distended abdomen
swinging fever with chills and rigor
Features of pyemia
SepticemiaHigh temperature with rigor
Headache, insomnia or mental confusion
Positive blood culture
Sign/symptoms of infection in the lungs,
meninges or joint
Culture and antibiotic sensitivity of
High vaginal and cervial swabs
Urine :Routine and microscopic examination
Culture if infection is suspected
Complete blood count-
UltrasonographyFor diagnosis of pelvic masses
Retained bits of placenta and/ or
Other specific investigation
Blood for malaria parasite
Improvement of general condition
Treatment of septic cocci
Abstinence from sexual intercourse in the last
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.
Staff attending on labor client should be free of
surgical asepsis to be taken while conducting
having respiratory tract infection or skin
infection should be admitted in single room or
should be kept intact as long as possible
and vaginal examination should be restricted to
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.
of the genital tract should be repaired
promptly and meticulously with perfect homeostasis
blood loss during delivery should be
replaced promptly by transfusion to improve the
general body resistance
antibiotic must be administered in cases
of premature rupture of membranes, prolonged labor
or following traumatic delivery.
aseptic precautions while dressing the
Restriction of the visitor in the postpartum
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
Infected mothers and babies are to be isolated
To keep the floor of the in – patient ward dust
free by frequent mopping.
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
Analgesics and sedatives are administered to
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
Infected wound of perineum valva and vagina
are laid open for drainage, cleaned and
dressed with antiseptic preparation.
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.
It is an infection of the urinary organs
such as kidney, ureter, urinary bladder
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
is one of the common cause of
puesperal pyrexia, the incidence
being 1- 5 % of all deliveries.
Raised temperature ( pyrexia)
Costovertebral angle pain
Supra pubic discomfort
Frequent and often painful micturation
Nausea and vomiting
UTI is confirmed by examination of an
uncontaminated midstream clean catch
sample for urinalysis and culture and
antibiotic sensitivity test.
drainage of urine