The document discusses puerperal sepsis and urinary tract infections. Puerperal sepsis is defined as an infection of the genital tract occurring after childbirth. Common causes include bacteria like Doderlein bacillus. Risk factors include prolonged rupture of membranes, operative deliveries, and retained placental tissues. Signs include fever, foul-smelling discharge, and pelvic pain. Treatment involves isolation, intravenous antibiotics like cefotaxime and metronidazole, and possible drainage of abscesses. Urinary tract infections in the postpartum period are also discussed, with E. coli being a common cause. Symptoms include fever and painful urination. Diagnosis is by urine culture and

1. PUERPERAL SEPSIS AND
URINARY TRACT INFECTION
BY:
MS. LAMNUNNEM HAOKIP
SENIOR TUTOR/LECTURER
OBG NURSING
SSNSR, SU

2. PUERPERIUM
Puerperium is the period following childbirth during
which the body tissues, specially the pelvic organs revert
back approximately to the pre-pregnant state both
anatomically and physiologically with in 6 wks.
The key to management of sepsis is early recognition,
aggressive resuscitation, antibiotic administration and
source control.

3. INCIDENCES
Worldwide, more than 500 000 women die of
complications of pregnancy and childbirth

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

5. COMMON PUERPERAL INFECTIONS
Endometritis
Endomyometritis
Endoparametritis
Combination of theses three is called
pelvic cellulitis.

6. CAUSATIVE ORGANISM
Doderlein bacillus (60-70%)
Yeast like fungus –candida albicans (25%)
Staphylococcus albus or aureus
Streptococcus –anerobic common
Beta hemolyticus streptococcus rare
E.coli

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

8. • 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
Intrapartum factors

9. PATHOGENESIS
• Transmitted by another person
• Source - midwife, doctor and other
patients or visitors
EXOGENOUS
• Causative organisms - Streptococcus
fecalis
• Anaerobic streptococci and
clostridium welchi found in the
vagina
ENDOGENOUS

10. SIGN AND SYMPTOMS
Local infection-
Slight raise in temperature, generalized malaise and
headache.
Redness and the swelling of the local wound
Pus formation and disruption of wound
Uterine infection- mild infection
Pyrexia of variable degree and tachycardia.
Red, copious, offensive lochia & tender and soft
uterus.

11. CONT…
Fever which occurs within 24 hours or more is the
first sign.
Increased Pulse rate .
The uterus is sub-involuted,.
Foul smelling vaginal discharge.
Local pain and swelling of the infected suture line.
Headache, insomnia and anorexia

12. 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 Douglas.

13. ⚫Bacteriological study-
Smear
Culture and antibiotic sensitivity of
purulent material
High vaginal and cervical swabs
Peritoneal fluids
Blood culture
INVESTIGATIONS

14.  Urine :-
 Routine and microscopic examination
 Culture if infection is suspected
 CBC Profile

15. Ultrasonography-
For diagnosis of pelvic masses
Pelvic abscess
Pelvic peritonitis
Retained bits of placenta and/ or membrane
Other:
X-Ray

16. PROPHYLAXIS
ANTENATAL
INTRANATAL
POSTNATAL

17. ANTENATAL
Improvement of general condition
Treatment of septic cocci
Abstinence from sexual intercourse in the last two
months
Care about personal hygiene – bathing in dirty water to
be avoided
Avoiding contact with people having infection, such as
cold, boils.
Avoiding unnecessary vaginal examinations and douches
in the later months.

18. INTRAPARTUM
Staff attending on labor client should be free of
infections.
Full surgical asepsis to be taken while conducting
delivery
Prophylactic antibiotic must be administered in cases
of caesarean section to reduced the incidence of
wound infection, endometritis UTI.
Ceftriaxone 1g IV immediately after cord clamping
and a second dose after 8 hours is recommended.

19. POSTPARTUM
Take aseptic precautions while dressing the perineal
wound
Restriction of the visitor in the postpartum ward
Mothers to be instructed to use sterile sanitary pads
and to change them frequently
Vulva and perineum to be cleaned with mild
antiseptic solution following urination and defecation
Infected mothers and babies are to be isolated

20. TREATMENT
1. ISOLATION OF PATIENT: specially when
haemolytic streptococcus is obtained on culture.
2. MAINTAIN INTAKE & OUTPUT
3. INDWELLING CATHETER: to relieve any urine
retention due to pelvic abscess.
4. ANTIBIOTIC: intravenous administration of
cefotaxim 1g, 8hrly & metronidazole 0.5g, every 8
hrly. The treatment is continued for at least 7-10
days.

21. SURGICAL INTERVENTION
PERINEAL WOUND:
• The stitches of the perineal wound may have to be
removed to facilitate drainage of pus and relieve pain
After the infection is controlled, secondary sutures
may be given later.
RETAINED UTERINE PRODUCTS
PELVIC ABSCESS :should be drained by
colpotomy under ultrasound guidance.
HYSTRECTOMY

22. URINARY TRACT
INFECTION

23. DEFINITION
It is an infection of the urinary organs
such as kidney, ureter, urinary bladder
and urethra.
The causative organisms are:
⚫ E. coli
⚫ Klebsiella
⚫ Proteus
⚫ Staphylococcus aureus

24. Others:
⚫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.

25. CLINICAL FEATURES
 Raised temperature ( pyrexia)
 Costovertebral angle pain
 Supra pubic discomfort
 Frequent and often painful micturition
 Nausea and vomiting

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

27. MANAGEMENT
Adequate intake of fluids
Adequate drainage of urine
Keeping the perineal area clean and hygienic
Frequent changing of inner wears
Used of clean warm water
Proper Antimicrobial therapy: Ceftriaxone 250 mg 6 hours apart or
500 mg 8 hours apart IV.

28. BIBLIOGRAPHY/REFERENCES
• Annamma Jabob. A comprehensive textbook of Midwifery and Gynaecological
Nursing, Fourth edition.
• Lily Podder. Fundamentals of Midwifery and Obstetrical Nursing. ELSEVIER.
• DC Dutta’s textbook of Obstetrics. Hiralal Konar 8th Edition.Jaypee The Health
Sciences Publisher.
• https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/puerperal-sepsis
• https://pubmed.ncbi.nlm.nih.gov/23993724/