Puerperium sepsis

1. PUERPERAL SEPSIS
COMPILED BY MRS MULUBE/TUTOR

2. GENERAL OBJECTIVE
 At the end of the lecture students should be able to have
an understanding of puerperal sepsis.

3. SPECIFIC OBJECTIVES
 Define puerperal sepsis
 Outline the causes and predisposing factors
 To state the signs and symptoms
 To outline the investigations and diagnosis
 To state the management
 To outline the prognosis and complications

4. INTRODUCTION
Puerperal Sepsis contributes to the maternal mortality
rate by 11% globally (Say, et al., 2014).
In Zambia 15% of maternal deaths are caused by
puerperal sepsis, regrettably the cause is
preventable (MOH, 2013).
Therefore, this calls for vigilance in providing
appropriate care to mothers by all the health
personnel.

5. CAUSES OF MATERNAL MORTALITY RATE

6. DEFINITION
Puerperal Sepsis
 Infection of the genital tract in the first six
weeks following labour or abortion.
characterized by temperature reaching 38
°C or more in 24 hours, at least two days of
the first 14 days post-delivery due to entry,
growth and multiplication of pathogenic
organisms (Sellers, 2010).

7. CAUSES OF PUERPERAL SEPSIS
Microorganisms
The causative organisms are either aerobic or
anaerobic. These could be endogenous or
exogenous.
 Beta-haemolytic streptococcus, group A, B and
D
 Staphylococcus aureus
 Escherichia coli
 Haemophilus influenza

8. CONT.…………….
o Gonococcus
o Pneumococcus
o Pseudomonas

9. MODE OF SPREAD
Autogenous
o Originates from the patient herself
o That is from the her nose, skin, vulva, throat,
faeces or any septic focus
Endogenous
o Occurs as a result of organisms already
present in the vagina
o Gains entry through bruised and lacerated birth
canal

10. CONT.…………..
Exogenous
o Occurs as a result of contamination from
attendants’ noses, throats, nails & clothes
o Also from the environment that inadequately
cleaned and dirty linen

11. PREDISPOSING FACTORS
ANTENATAL FACTORS
 Antenatal intrauterine infections
 Premature rapture of membranes (PROM)
 Antepartum hemorrhage (placenta praevia)
 Chronic infections-anemia, diabetes mellitus

12. CONT……………
INTRA-PARTUM FACTORS
o Bruises and lacerations
 Caesarian section
 Internal podalic version
 Multiple vaginal examinations

13. CONT……………
 Instrumental deliveries
 Prolonged labour
 Unsterilized instruments
 Manual removal of the placenta
 Retained products of conception

14. CONT……………..
POSTNATAL FACTORS
• Unhygienic practices
• Poor wound care/episiotomies

15. SIGNS AND SYMPTOMS
 Fever 38 degrees Celsius
 Tachycardia
 Pelvic thrombophlebitis
 Uterus – sub-involuted, boggy, tender and
larger

16. CONT…………….
 Infected wounds – caesarian/ perineal
 Local pain and swelling of the infected
suture line.
 Malaise, headache, chills, rigors and
insomnia

17. CONT……………..
 Foul smelling lochia (brownish in colour)
 Secondary post-partum haemorrhage
 Severe infection of the fallopian tubes

18. CONT……………..
 Collection of pus in the pouch of Douglas
 Anorexia
 Diarrhea

19. DIAGNOSIS
Detailed history taking on;
 General condition during pregnancy
 Summary of labour
 Place of delivery
 Type of labour and delivery whether
prolonged or instrumental

20. CONT……………..
o Onset of fever
o Vital signs
o Physical examination from head to toe

21. INVESTIGATIONS
 Pelvic ultra-sonogram
 Mid-stream specimen of urine
 High vaginal swab
 Endocervical swab

22. CONTI………………
 Throat swab from patient to isolate the
causative microorganism
 Nose swab from patient
 Full blood count
 Blood culture and sensitivity
 Bleeding and clotting time

23. CONT……………………….
 Blood slide

24. MEDICAL MANAGEMENT
Puerperal sepsis needs prompt treatment with
triple antibiotics to combat all the possible
causative organisms. These include;
 Amoxyl; 500 mg three times daily for five-
seven days.
 Gentamycin, 80mg three times daily for five-
seven days (IM)

25. CONT………….
 Ampicillin, 500 mg, 6 hourly, I.V/ Oral for
five- seven days.
o Metronidazole, 400mg, Oral,(I.V 400mg)
three times daily or 8 hourly, for 5-7days
Analgesics
 Pethidine 50-100mg 8 hourly maximum of
three doses.

26. CONT………….
o Diclofenac, 75-100mg, three times daily, for
3 days, orally
o Paracetamol, 1 g, 3 times daily, orally for 3
days
o Brufen, 400 mg, 3 times daily, orally for
3days

27. CONT………..
Surgical treatment
o Perineal wound- remove stitches
o Pelvic abscess- Laparatomy
o Retained products of conception-MVA
Intravenous fluids
o Required in severe cases for flushing out
toxins and for drug administration.

28. CONT………….
Blood transfusion
If the patient has severe anemia

29. MIDWIFERY CARE
 Psychological care
 Isolation
 Rest
 Observations
 Hygiene

30. CONT…………
 Exercise
 Nutrition
 Elimination

31. PROGNOSIS
 Antibiotic therapy and other treatment
measures are virtually always successful in
curing puerperal infections.
 Improved with early detection
and appropriate medical and nursing
management

32. PREVENTION OF PEUPERAL SEPSIS
ANTENATALLY
 Educate the patient on the importance of
hygiene, adequate rest and sleep
 Early antenatal booking for early detection
and treatment of infection and diseases
 Good nutrition
 Importance of hospital delivery

33. INTRAPARTUM
 Isolate patient with infections
 Aseptic technique in all procedures
 Minimize vaginal examinations
 Reduce traffic in labour ward
 Antibiotic cover in PROM
 Use of partograph

34. CONT.………..
 Avoid unnecessary episiotomies
 Medical staff attending to patients should be
free from upper respiratory infections
 Inspect placenta carefully to make sure there
are no retained products of conception
 Ensure that dump dusting is done every day to
prevent dust accumulation

35. CONT.……….
 Train traditional birth attendants (TBAS) on
how to conduct clean and safe deliveries
 Encourage frequent opening of the bladder
to avoid retained urine

36. POSTPARTUM
 Isolate infected patients
 Promote personal hygiene
 Aseptic techniques in procedures like vulva
toilet
 Control of staff infections such as
respiratory tract infections

37. CONT.……..
 Record vital signs accurately
 Prompt treatment of complications such as
perineal tear

38. COMPLICATIONS
 Peritonitis -Due to spread of infection to the
peritoneum
 Septicemia-Untreated infection invades the
vascular system
 Infertility-Following salpingitis where there
may be blockage of fallopian tubes leading
to healing by scaring

39. CONT.………….
 Anaemia-Due to haemolysis of the red
blood cells
 Cervicitis-Inflammation of the cervix
 Salpingitis, -Inflammation of the fallopian
tubes
 Thrombophlebitis-Inflammation of the veins

40. CONT.………….
 Endometritis-Inflammation of the
endometrial
 Pelvic abscess-due to a highly localized
infection
 Disseminated intravascular coagulopathy
due to toxins from the bacteria.

41. REFERENCES
Ngoma, C.M. (2003). Reproductive health with a focus on
safe motherhood. Lusaka: Zambia Educational
Publishing House .
Pauline M. S. (2010). Midwifery, Volume 2, 12th edition,
Juta and Co. Ltd.
Say L. et al. (2014). Global Causes of Maternal Death:
A WHO Systematic Analysis. Lancet.