This document discusses several abnormalities that can occur during the postpartum period, known as the puerperium. It defines puerperal pyrexia as a temperature over 100°F occurring on two occasions within the first 10 days postpartum. Puerperal sepsis is defined as an infection of the genital tract occurring as a complication of delivery. Common causes of infection include bacteria like Staphylococcus and Streptococcus. Risk factors, signs and symptoms, treatments and management strategies are described for various postpartum infections and other issues like subinvolution, urinary tract infection, breast engorgement, and cracked nipples.

1. ABNORMALITIES
OF THE
PUERPERIUM

3. A rise of temperature reaching 1000F (380 C)
or more (measured orally) on 2 separate occasions
at 24 hrs apart (excluding first 24 hours) within first
10 days following delivery is called Puerperal
pyrexia.
DEFINITION

4. PUERPERAL SEPSIS
URINARY TRACT INFECTION
MASTITIS
CAUSES…

5. INFECTION OF CAESAREAN SECTION
WOUND
PULMONARY INFECTION
A RECRUDESCENCE OF MALARIA /
PULMONARY TUBERCULOSIS

6. PUERPERAL
SEPSIS

7. An infection of the genital tract which occurs
as a complication of delivery is termed
puerperal sepsis
DEFINITION

8.  Marked decline in cases:
 Improved obstetric care
 Availability of wider range of antibiotics
INCIDENCE

9. Endometritis
Endomyometritis
Endoparametritis

10. • Doderlein bacillus (60-70%)
• Yeast like fungus –candida albicans
(25%)
• Staphylococcus albus or aureus
• Streptococcus –anerobic common
• E.coli
• Clostridium welchii

12. PATHOGENIC FACTOR
FOR VAGINAL FLORA
The cervicovaginal mucous membrane is damaged even in
normal delivery and the uterine surface too, specially at the
placental site
is converted into open wound by the seperation 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.

13. • Malnutrition and anemia
• Preterm labor
• Premature rupture of
membrane
• Chronic debilitating
illness (HIV)
• Prolonged rupture of
membrane >18hrs
• Diabetes

14. • Repeated vaginal examination
• Traumatic operative delivery
• Retained bits of placental tissue or membrane.
• Prolonged labour
• Hemorrhage
• Caesarean delivery

15. Puerperal infection is an wound infection. The
primary sites of the infection are:-
 Perineum
 Vagina
 Cervix
 Uterus

16. PERINEUM
Laceration of the perineum are likely to be
infected.
The wound edges become red and swollen.
There may be collection of purulent discharge
resulting in complete disruption of the wound.

17. VAGINA
Vaginal laceration are infected directly or by
extension from the perineal infection.
The mucosa is swollen and hyperaemic,
resulting in necrosis and sloughing

18. Cervix:-
The cervical laceration becomes the site of infection
Uterus :-
The uterus is most common site of infection
Decidua (placental site) is common site and infected
first
The infection usually manifests between 3rd and 6th
day of delivery

19. Pelvic cellulitis:- (lymphatics
/blood route)
• Causes exudation n formation
of indurated mass confined to
one side of the uterus

20. Salpingitis:- (lymphatic spread)
 infection of the fallopian tube
and ovaries with the formation of
tubo ovarian mass
Peritonitis :-
Localised pelvic abscess

21. Thrombophelebitis :-
Ovarian vein of one side is usually involved
Uterine vein may also involved
Suppuration n embolism to other organs
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”

22. Local infection-
Slight rise in temperature, generalised
malaise and headache.
Redness and the swelling of the local wound
Pus formation and disruption of wound
Uterine infection-
 Mild:
Pyrexia of variable degree and tachycardia.
Red, copius and offensive lochia.
Subinvoluted, tender and soft uterus.

23. Sever infection-
Fever with chills and rigor
Rapid pulse
Scanty, odorless lochia
Subinvoluted uterus
Parametritis-
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

24. Pelvic peritonitis:-
Pyrexia with increased pulse rate
Lower abdominal pain and
tenderness
Collection of the pus in pouch of
douglas

25. Generalised peritonitis:-
High fever with rapid pulse
Vomiting
Abdominal pain
Tender and distended abdomen
Thrombophelebitis –
swinging fever with chills and rigor
Features of pyemia

26. 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

27. Bacteriological study-
Smear
Culture and antibiotic sensitivity of
purulent material
High vaginal and cervial swabs
Peritoneal fluids
Blood culture

28. Urine :-
Routine and microscopic
examination
Culture if infection is suspected
Complete blood count-

29. Ultrasonography-
For diagnosis of pelvic masses
Pelvic abscess
Pelvic peritonitis
Retained bits of placenta and/ or membrane

30. Other specific investigation
X – ray
Blood for malaria parasite

31. SUBINVOLUTION

32. When the involution is impaired or retarded
it is called subinvolution.
DEFINITION

33.  Grand multiparity,
 twins and hydramnios,
 Maternal ill health,
 Cesarean section,
 Prolapse of the uterus,
 Uterine fibroid.
CAUSES:

34. • The condition may be asymptomatic.
(1)Abnormal lochial discharge either excessive
or prolonged,
(2)Irregular or at times excessive uterine
bleeding,
(3) Irregular cramp like pain in cases of
retained products or rise of temperature in
sepsis
SYMPTOMS:

35. (1) The uterine height is greater than the normal for
the particular day of puerperium. It feels boggy and
softer.
(2) Presence of features responsible for subinvolution
may be evident.
SIGNS:

36. Appropriate therapy is to be instituted only when
subinvolution is found to be a mere sign of some local
pathology:
(1)Antibiotics in endometritis,
(2)Exploration of the uterus in retained products,
(3) Pessary in prolapse or retroversion.
MANAGEMENT

38. It is an infection of the urinary organs such as
kidney, ureter, urinary bladder and urethra.

39. • E. coli
• Klebsiella
• Proteus
• Staphylococcus aureus

40. 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.

41. It is one of the common cause of
puerperal pyrexia, the incidence
being 1- 5 % of all deliveries.

42. UTI is confirmed by examination of an
uncontaminated midstream clean catch sample for
urinalysis and culture and antibiotic sensitivity
test.

43.  High fluid intake
 Adequate drainage of urine
 Appropriate antimicrobial
therapy.

44. BREAST
ENGORGEMENT

45. CAUSES
Due to exaggerated normal
venous and lymphatic
engorgement.
Prevent the escape of milk from
lacteal system.

46. INCIDENCE
In primiparous

47. ONSET
Third and forth day
postpartum

48. SYMPTOMS
Pain
Heaviness in both breast
Malaise
Rise of temperature
Painful breast feeding

50. PREVENTION
Avoid prelacteal feeding
Initiate breast feeding early
and unrestricted
Exclusive breast feeding on
demand
Feeding in correct position

51. TREATMENT
Breast supports
Manual expression of
remaining milk after each feed
In severe condition use breast
pump

52. CRACKED AND
RETRACTED
NIPPLES

53. IT OCCURS DUE TO LOSS
OF SURFACE EPITHELIUM
OR DUE TO A FISSURE
SITUATED AT THE TIP OR
BASE OF THE NIPPLE

55. CAUSE
Crust formation over nipple due
to unhygiene
Retracted nipple
Trauma from baby's mouth

56. SYMPTOMS
Asymptomatic condition
pain while feeding

57. PROPHYLAXIS
Local cleanliness during pregnancy
and in puerperium before and after
each feeding

58. COMPLICATION
Mastitis

59. TREATMENT
 Correct attachment will provide
immediate relief from healing and
pain
 Fresh human milk and saliva have
got an healing property
 breast pumps in severe cases