Puerperal sepsis is a serious infection of the genital tract that occurs after childbirth, usually within 10 days. It is a leading cause of preventable maternal mortality. Risk factors include malnutrition, anemia, prolonged rupture of membranes, and unhygienic delivery practices. Common symptoms include fever, foul-smelling discharge, and pelvic pain. Treatment involves antibiotics based on culture and sensitivity testing, with surgical drainage of abscesses if present. Prevention relies on clean delivery practices and treatment of infections.

1. PUERPERAL SEPSIS
Presentedby
Mrs. Pooja Chaware
MSc Nursing (OBG)
VMPCON AKLUJ

2. INTRODUCTION
•Sepsis is the leading causes of
preventable maternal death not only in
developing countries but in developed
countries as well.
•It is an important public health problem
contributing to maternal morbidity and

3. DEFINITION
•An infection of genital tract which occurs as a
complication of delivery usually within 10 days is termed
as puerperal sepsis.
•Puerperal sepsis is commonly due to-
1. Endometritis 2. Endomyometritis 3. Endoparametritis or
a combination of all these when it is called as pelvic
cellulitis.

4. RISK FACTROS
Antepartum factors
•Malnutrition and anaemia
•Preterm labour
•Premature rupture of the membrane
•Prolong rupture of the membrane > 18 hours
•Low socio economic status
•Lack of antenatal care
•Coitus during late pregnancy

5. •Intrapartum factors
•Frequent vaginal examination
•Premature rupture of the membrane
•Prolong labour
•Chorioamnionitis
•Traumatic operative delivery
•Haemorrhage – antepartum or postpartum
•Retained bits of placental tissue or membranes
•Caesarean delivery

6. MICROORGANISMS RESPONSIBLE FOR PUERPERALSEPSIS
• Aerobic microorganism
Streptococcus haemolyticus Group A, E coli, beta haemolytic
streptococci, non-haemolytic streptococci, staphylococci, klebsiella,
Pseudomonas, gonococci
•Anaerobic microorganism
Anaerobic streptococci, cl. welchi, tetani, mycoplasmas, chlamydia

7. MODE OF INFECTION
•Endogenous: due to organism present in the vagina and
cervix
Ex: Anaerobic streptococci which is predominant
pathogen.
•Autogenous: Bacteria from some other part of the body
Ex: Streptococcus haemolyticus Group A, E coli,
staphylococci are important.

8. •Exogenous: where infection is contracted
from sources outside the patient (from
hospital or attendants).
Ex: beta haemolytic streptococci, E coli
are important.

9. PATHOLOGY
•The primary sites of infection are:
•Perineum
•Vagina
•Cervix
•Uterus
The infection is neither localised to the site or spread to
distant sites.

10. The lacerations on the perineum, vagina, cervix is often
infected by organisms due to presence of blood clot or
dead space.
The wound become red, swollen and there is associated
seropurulent discharges.
•Diabetes, obesity, low nutritional status is the other high-
risk factors for wound infection.

11. PATHOGENESIS
Endometrium (placental implantation site) , cervical
lacerated wound , vaginal wound or perineal lacerated
wound are the favourable sites for bacterial growth and
multiplication.
Endometrium (placental implantation site) , cervical
lacerated wound , vaginal wound or perineal lacerated
wound are the favourable sites for bacterial growth and
multiplication.

12. CLINICAL FEATURES
Symptoms
Onset is usually 2-3 days after delivery (in severe cases in 24
hours)
•Fever with chills and rigor
•Generalized malaise
•Headache
•Nausea, anorexia, vomiting
•Foul smelling discharge (lochia)

13. •Sign
• General examination
•Toxic appearance
•Fever (101-102-degree F, rarely higher)
•Shock
•Skin eruption or jaundice
•Calf tenderness suggest deep vein
thrombosis

14. •Local examination
• -- Episiotomy appears swollen, red oedematous,
pouting. Wound edges may be red, oedematous and extruding
greenish or yellowish offensive pus.
-- Red, purulent, foul smelling lochia
•Per vaginal examination
--Uterus sub involuted, boggy, and tender.
Bogginess in the fornices or pouch of Douglas suggests pelvic
abscess / mass.

15. SIGN ANDSYMPTOMS OF COMPLICATION
•Pelvic abscess
- A tender fluctuating bogginess of the Douglas
pouch is felt by P /V
- Rectal symptoms like tenesmus and diarrhoea may
developed.
Pelvic peritonitis
•fever, tachycardia and vomiting
•lower abdominal pain, tenderness and rigidity

16. Generalised peritonitis
• high fever with a rapid pulse
• vomiting
• Generalised abdominal pain
• Patients looks very ill and dehydrated
• Abdomen is tender and distended.
Thrombophlebitis
• Extension of infection to the pelvic veins leads to high fever, rapid pulse
and deep-seated pelvic pain
•
• If extension progresses to the femoral vein, pain and tenderness extends to
the leg, which becomes swollen, oedematous and hot.

17. Grade1
Infection localized within the uterine
cavity
Grade2
Infection involving the parametrium
Grade3
Generalized infection with
Septicaemia
There is high raise of temperature with rigor, severe headache.
Blood culture is positive
Grades of puerperal sepsis

18. INVESTIGATION
To confirm the diagnosis
•High vaginal / cervical swab : smear , culture , antibiotic
sensitivity
•Urine routine and SOS culture
•CBC haemoglobin, WBC total /differential count
•ESR
•Peripheral smear to rules out malaria
•X ray chest
•Blood culture: during the peak of temperature.

19. To know the extent
•USG
•X -ray of abdomen and pelvis
•Culdocentesis

20. COMPLICATIONS
•Peritonitis
•Septicaemia, shock
•Abscess: pelvic, sub phrenic, sub hepatic
•Septic pelvic thrombophlebitis
•Death: septicaemia, shock, gas gangrene,
tetanus

21. MANAGEMENT
General care
•Isolation of the patient
•Adequate fluid and calorie
•Anaemia is corrected by oral iron or if needed by blood
transfusion.
•An indwelling catheter is used to relieve any urine retention
due to pelvic abscess.
•A chart is maintained by recording pulse, respiration,
temperature, lochia discharge and fluid intake and output.

22. Antibiotics:
•Ideal antibiotic regimen should depend on the culture and
sensitivity report. Pending the report, Gentamicin
(2 mg / kg IV loading dose followed by 1.5 mg /kg IV every
8 hrs) and Ampicillin (1g IV every 6 hours) or Clindamycin
(900 mg IV every 8 hrs) should be started. Metronidazole
0.5g, IV is given at 8 hrs interval to control the anaerobic
group.
The treatment is continued until the infection is controlled
for at least 7 – 10 days.

23. SURGICAL TREATMENT
•Perineal wound: The stitches of the perineal wound
may have to be removed to facilitates drainage of pus
and relieve pain.
•The wound is to be cleaned with sitz bath several
times a day and is dressed with antiseptic ointment or
powder.

24. •Retained uterine products are surgically
evacuated after antibiotic coverage for 24 hours
should be done to avoid the risk of septicaemia.
Cases with septic pelvic thrombophlebitis are
treated with heparin for 7-10 days.
•Pelvic abscess should be drained by colpotomy
under ultrasound guidance.

25. •Wound dehiscence: Wound dehiscence of episiotomy or
abdominal wound following caesarean section is managed
by scrubbing the wound twice daily, debridement of all
necrotic tissue and then closing the wound with secondary
sutures.
•Laparotomy has got a limited indication. Maintenance of
electrolyte balance by intravenous fluids along with
appropriate antibiotics therapy usually controls peritonitis.

26. •Hysterectomy is indicated in cases with ruptured or
perforation, having multiple abscess, gangrenous uterus or
gas gangrene infection. Ruptured tubo- ovarian abscess
should be removed.

27. SUMMARY

28. CONCLUSION
•Puerperal sepsis is an important public health
problem contributing to maternal morbidity and
mortality.
•Majority of predisposing factors are preventable.
Optimal antiseptic measures and careful monitoring
are needed throughout the labour process.

29. BIBLIOGRAPHY
•1 . D.C Dutta ,Text book of obstetrics and gynaecology ,5th
edition page no 432
•2. Dawn C.S, Text book of obstetrics and gynaecology,
Dawn Books, Calcutta. Page on 457
•3. Bennet V Ruth and Brown K Linda ,Myle” text Book For
Midwives. Page no 501
•4. Menon Krishna and Palaniappan, Clinical Obstetrics, 9th
edition Orient Longman, 1990, Madras.