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PUERPERAL

INFECTION
Puerperal

fever
Postpartum fever
Puerperal sepsis
Childbed fever

DEFINITION :
Bacterial infection following
childbirth
Infection of the birth canal after the
first 24
hours following delivery of a baby
Temperature > 38o C (taken by
mouth, 4
times daily)
Occur on any two of the first 10 days

Predisposing factors
1. Antepartum factors
Anemia
Nutrition
Sexual intercourse
PROM
2. INTRAPARTUM FACTORS

Iatrogenic introduction of pathogen


bacteria (into the birth canal)
Trauma (devitalizes tissue)
Hemorrhage

PATHOLOGY
Decrease of protective mechanism
Plasental site = portal of entry
The lochia = excellent culture
media
Ascending infection

Episiotomy infection
Perineal lacerations infection
Lesions of vulva/vagina and
cervix
do not occur more often
(due to excellent local blood supply)
large episiotomy greater risk
Vaginitis/Servicitis infection
during pregnancy
Bad hygiene

Episiotomy infection

Clinical findings :
Pain at episiotomy site
Dysuria with or without urinary
retention
Disruption of the wound
Gaping incision
Necrotic debris / pus
Body temp. < 38.5 oC

Episiotomy infection

Treatment :`
Cleaning the wound
Promoting formation
granulation
tissue
Debridement (Warm Sitz baths)
Perineoraphy

ENDOMETRITIS
Etiology :
PROM
Chorioamnionitis
Excessive number of vaginal
examinations
Prolonged labor
Vaginitis/Cervicitis

ENDOMETRITIS.

Intrauterine pressure
catheter
Low sosioeconomic status
Operative vaginal deliveries
Poor nutrition
Coitus near term

Endometritis

Clinical findings :
Symptoms and Signs :
Fever (between 38 oC s/d 40
o
C)
Soft & tender uterus
Lochia foul odor

Endometritis..

LABORATORY FINDINGS :
* Leukocytosis

* Urinalysis (pyuria/Bacterial
cultures) * Lochia cultures
* Sensitivity antimicrobial test

Endometritis.
Treatment :
Antibiotics ( Aerob & Anaerob
m.o)
(Ampicillin + Aminoglycosides)
(Cephalosporine 2nd/3rd
generation)
(Clyndamycin)
Uterotonic
Fowler position

Extension of Puerperal
Infection
1. Extension via superficial
epithelization
(Percontinuitatum)

Endometritis
Salpingitis
Pelveoperitonitis
Peritonitis

Extension of Puerperal infection.


2.

Extension via veins


Phlebitis Sepsis
Periphlebitis
Parametritis

Extension via uterine


wall
Endometritis
Myometritis
Perimetritis
Parametritis
4. Extension via
Lymphatic
Limphangitis
Perilimphangitis
Parametritis
3.

Extension of puerperal infection in


peritonitis

Salpingitis :

Most often with


postpartum
sepsis
Gonorrheal salpingitis
(rare)
infertility

Pelvic Cellulitis (Parametritis)

Common cause of prolonged sustain


fever
Tenderness of the lower abdomen
(one or both sides)
Tenderness of vaginal examination
Fixation uterus by parametrial
exudate
Mass in broad ligament

Extension of puerperal infection in


pelvic (parametritis)

Septic Thrombophlebitis :
Repeated chills

Swings in the temperature


Hypotension
Lasted for many weeks
Severe complication :

pneumonitis
infarction
abscesses
septic embolism

Extension of puerperal infection in


peritonitis

Extension of puerperal infection in pelvic


thrombophlebitis.

Peritonitis
Severe abdominal
pain
Abdominal rigidity
Marked bowel
distension
Paralytic ileus

Treatment :
Choice of antibiotics
(penicillin + gentamycin)
(penicillin + aminoglycosides)
(clindamycin + gentamycin)
(penicillin + tetracycline)
Analgetic
Fluid & Electrolyt
Operative

PREVENTIVE CARE
1.During Pregnancy
anemia
nutrition
genital infection
coitus near term

PREVENTIVE CARE...

2. During parturition
Safe and Clean delivery
avoid infection (hygiene/antiseptic
procedure)
avoid large episiotomy
avoid bleeding
avoid prolonged labor
3. During puerperium
Hygiene