Complications of puerperium

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Complications of puerperium

  1. 1. Complications of Puerperium Puerperal pyrexia Problems with breast feeding Coagulation disorders Psychiatric disorders
  2. 2. 1: Puerperal Pyrexia        Genital tract infection(PUERPERAL SEPSIS) Breast infection Respiratory tract infection Urinary tract infection Thrombophlebitis Wound infection Other causes of pyrexia
  3. 3. a: Puerperal Sepsis       Pyrexia after labour or abortion persisting for more than 24 hours One of the major cause of Maternal Mortality and is PREVENTABLE Delivery/abortions without aseptic precautions SIMMELWEIS(Chlorinated water) PASTEUR(microrganisms are responsible) Antibiotics (Sulphonamides 1935,penicillins)
  4. 4. Aetiology      Extensive raw area left after placental separation Cervix,vaginal tears Fourchette Perineum Abdominal wound
  5. 5. Micro-organisms        Coliform organisms Enterococcus Anaerobic bacteria Clotridium welchii Streptococcus Group B,C,D Staph aureus…resistant strains in hospital staff Hemolytic streptococcus …Group A
  6. 6. Presentation      Mild Pelvic peritonitis General peritonitis Septicemia Pleural,pericardial and joints
  7. 7. Diagnostic work up          Head to toe examination HVS for culture and sensitivity Urine Blood Isolation Barrier nursing Analgesia Hydration Surgical cleaning
  8. 8. b: Urinary tract infection       Most common cause of puerperal pyrexia E coli Catheterization Treatment : adequate hydration antibiotics
  9. 9. c: Other causes      Respiratory tract infections Others: Tonsillitis Influenza Appendicitis etc
  10. 10. 2: Breast feeding problems
  11. 11. Breast Feeding Practices  Baby Friendly Hospitals  Exclusive breast feeding  Breast feeding within half hour of delivery
  12. 12. Problems in breast feeding        Engorgement of breasts Cracked nipples Acute Mastitis…staph aureus Breast abscess Suppression of lactation Galactocele(retention cyst) Carcinoma breast
  13. 13. 3 :Thromboembolism       Platelet count …rises by 30 % Factor vii,vii and ix also rise Stasis Damage to endothelium Anemia Risk of pulmonary embolism :(No 1 cause of Maternal mortality in West)
  14. 14. Treatment     Prevention Heparin LMWH Oral anticoagulants
  15. 15. 4: Psychiatric disorders        A biochemical change? Physical change in body affecting brain? Psychological stress Concern about baby Experience of labour Change in sexual interest, loss of attractiveness Nausea,backache etc
  16. 16. Minor psychiatric disorders (post partum blues)       Anxiety ? How to diagnose? Resolution is a must Reassurance Social support Follow up
  17. 17. Neurotic disorders     Anxiety neurosis Depressive neurosis…tearfulness,insomnia, mood changes Requires…reassurance ,benzodiazepines In severe cases …antidepressants
  18. 18. Puerperal psychosis        Gloomy and self blaming and hopelessness Guilty feeling Hallucinations Suicidal risk Infanticidal attempts Schizophrenia …………………………………………

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