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Puerperal pyrexia & sepsis
- 1. Puerperal Pyrexia & Sepsis Ms.Sasikalavathi Arunachalam MSc (N) OBG Principal Haryana College of Nursing, Ellenabad
- 2. Puerperal Pyrexia A rise of temperature 100.4 degree F or more on 2 separate occasions at 24 hrs apart within first 10 days following delivery.
- 3. Causes Puerperal sepsis UTI Mastitis Infection of CS wound Pulmonary infection Septic pelvic thrombo- phlebitis PUO
- 4. Puerperal sepsis An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis
- 5. Vaginal flora • Doderlein’s bacillus • Candida albicans • Staphylococcus albus • Staphylococcus aureus • E.coli • Cl.welchi on occasion
- 6. Factors alter the vaginal flora • Damage of the cervico vaginal mucus membrane • Open wound of placental site • Blood clots present at the placental site
- 7. Predisposing factors of puerperal sepsis • Low host resistance • Introduction of microorganisms from outside • Increased prevalence of organisms resistant to antibiotics
- 8. Antenatal factors Malnutrition & anemia Pre term labour PROM Chronic debilitating illness Prolonged rupture of membranes > 18 hrs
- 9. Intranatal factors Repeated vaginal examination Prolonged rupture of membranes Dehydration & keto- acidosis during labour Traumatic operative delivery APH & PPH Retained bits of placental tissue Placenta praevia CS
- 11. Mode of infection Endogenous Autogenous Exogenous
- 12. Pathology • Perineum • Vagina • Cervix • Uterus - endometritis
- 13. Spread of infection • Pelvic cellulitis ( parametritis ) • Salpingitis • Septic pelvic thrombophlebitis • Septicaemia • Septic shock
- 14. C/F 1) Local infection • Slight rise of temperature • Generalized malaise or head ache • Red & swollen wound • Pus • When severe there is high rise of temperature with chills & rigor
- 15. 2) Uterine infection Mild • Rise of temperature and pulse rate • Offensive and copious lochial discharge • Subinvolution Severe • Rise of temperature with chills and rigor • Rapid pulse rate • Scanty and odourless lochia • Subinvolution • Associated wound infections
- 16. 3)Spreading infection Parametritis • Constant pelvic pain • Tenderness on either sides of hypogastrium • If suppuration – rise of temperature with chills and rigor, intense pain • Gradual deterioration • Leucocytosis Pelvic peritonitis • Pyrexia with increased pulse rate • Lower abdominal pain and tenderness • Collection of pus in pouch of doughlas General peritonitis • High fever with rapid pulse • Vomiting • Generalized abdominal pain • Dehydrated • Tender & distended abdomen • Rebound tenderness
- 17. Investigations History collection Physical examination High vaginal & endocervical swab for C/s Urine analysis & C/s Blood R/E, C/sUltrasonagraphy CT Scan MRI X-ray chest Sr. electrolytes Urea
- 18. Treatment Isolation Adequate fluid & calories Anemia to be corrected Analgesics Catheterization Vital signs I/o chart Antibiotics Laparotomy for unresponsive peritonitis Hysterectomy if ruptures
- 19. Management of bacteraemia & septic shock Fluid & electrolytes balance Monitor CVP Respiratory support Circulatory support Infection control
- 20. Thank U