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PRESENTED BY :
MS. VRUTI PATEL,
F.Y.M.SC. NURSING,
SCN
INTRODUCTION
worldwide, more than 500 000 women die of
complications of pregnancy and childbirth.
PUERPERAL PYREXIA
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.
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
CONTI…
• PPD 2-3: ENDOMETRITIS
 Emergency cesarean section
 Prolonged membrane rupture
 Prolonged labor
Multiple vaginal examinations during labor
• PPD 4-5: WOUND INFECTION
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
CLINICAL FINDINGS AND
MANAGEMENT
PUERPERAL SEPSIS
Definition :
An infection of the genital tract
which occurs as a complication of delivery is
termed puerperal sepsis.
PREDISPOSING FACTORS
Antepartum factors :
•Malnutrition and anaemia
•Preterm labor
•Premature rupture of the membrane
•Chronic deliberating illness
•Prolonged rupture of the membrane
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
CAUSES
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
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
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
PROPHYLAXIS
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
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
Puerperal sepsis
Puerperal sepsis

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Puerperal sepsis

  • 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.
  • 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
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 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
  • 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
  • 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