This document discusses puerperal pyrexia, which is a temperature of 100.4°F or higher within the first 10 days following delivery. It defines puerperal pyrexia and notes its historical prevalence. The causes are listed for different time periods postpartum, including atelectasis, urinary tract infections, endometritis, wound infections, and mastitis. Puerperal sepsis is also defined as an infection of the genital tract occurring after delivery. Risk factors and causes are provided. Signs and symptoms, investigations, prophylaxis, treatment including isolation, antibiotics, and potential surgical interventions are summarized.

1. PRESENTED BY :
MS. VRUTI PATEL,
F.Y.M.SC. NURSING,
SCN

2. INTRODUCTION
worldwide, more than 500 000 women die of
complications of pregnancy and childbirth.

3. PUERPERAL PYREXIA

4. DEFINITION
A rise of temperature reaching 100.4˚F
(38˚C) or more (measured orally) on separate
occasions at 24 hours apart (excluding first 24 hours)
within first 10 days following delivery is called
puerperal pyrexia.
Puerperal fever or childbed fever in the
18th and 19th centuries affected, on average, six to 9
women in every 1,000 deliveries, killing two to three
of them with peritonitis or septicemia.

5. CAUSES
• PPD 0: ATELECTASIS
– general anesthesia
– cigarette smoking
– obstructive lung disease
• PPD 1-2: URINARY TRACT INFECTIONS
- Multiple catheterization during labor
- Multiple vaginal examinations during labor
- Untreated bacteriuria

6. CONTI…
• PPD 2-3: ENDOMETRITIS
 Emergency cesarean section
 Prolonged membrane rupture
 Prolonged labor
Multiple vaginal examinations during labor
• PPD 4-5: WOUND INFECTION

7. CONTI…
• PPD 5-6: SEPTIC PELVIC THROMBOPHLEBITIS
 Emergency cesarean section
 Prolonged membrane rupture
 Prolonged labor
 Diffuse difficult vaginal delivery
• PPD 7-21: MASTITIS
 Nipple trauma from breastfeeding

8. CLINICAL FINDINGS AND
MANAGEMENT

14. PUERPERAL SEPSIS
Definition :
An infection of the genital tract
which occurs as a complication of delivery is
termed puerperal sepsis.

15. PREDISPOSING FACTORS
Antepartum factors :
•Malnutrition and anaemia
•Preterm labor
•Premature rupture of the membrane
•Chronic deliberating illness
•Prolonged rupture of the membrane

16. Intrapartum factors :
•Repeated vaginal examination
•Prolonged rupture of the membranes
•Dehydration and keto-acidosis during labor
•Traumatic operative delivery
•Haemorrhage - antepartum or postpartum
•Retained bits of the placental tissue or membranes
•Placental praevia – placental site lying close to the
vagina
•Caesarean delivery

17. CAUSES

18. SIGNS AND SYMPTOMS
• Fever which occurs within 24 hours or more is
the first sign
• Increased Pulse rate
• The uterus is sub-involuted, tender and softer
than usual
• Foul smelling vaginal discharge
• Local pain and swelling of the infected suture
line
• Headache, insomnia and anorexia

19. In severe sepsis :
•Constant pelvic pain
•Rise in temperature with increased pulse rate
•Lower abdominal pain
•Intense pain which worsens the condition of the
patients
•Severe infection of the fallopian tubules
•Collection of pus in the pouch of doughles

20. INVESTIGATION
• History
• Clinical examination
• High vaginal and endocervical swabs for culture
• Mid stream urine for analysis and culture
• Blood for total and differential count,
haemoglobinestimation
• Blood culture if fever is associated with chills and
rigor
• Pelvic ultrasound
• X-ray chest
• Blood urea and electrolytes

21. PROPHYLAXIS

22. TREATMENT
1. Isolation
2. Ventilation
3. Intake
4. Proper rest
5. Mild laxatives
6. Vital signs
7. Regular bathing or sponging
8. Aseptic dressing
9. Vaginal pads
10.Antibiotics
11.Resuscitative procedures

23. SURGICAL INTERVENTION
1.Open and drain infected episiotomy
2.Clot removal or by-pass
3.Prompt and aggressive exploration and
debridement of necrotic tissue
4.Hysterectomy