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IDENTIFICATION DATA

NAME OF THE HOSPITAL NRS MC&H

NAME : Sabita Pal

AGE : 24 Years

SEX : Female

ADDRESS C/O-Jagannath Pal,Vill. Dhamua, P.S.


Magrahat, 24 Pg(S)

BED NO. : 15

WARD : Postnatal

REG. NO. : RG 1045210

DATE OF ADMISSION : 22/02/2017

UNDER DOCTOR : Unit – III

GPAL G1P1A0L1

PERIOD OF GESTATION 40 weeks

DATE AND TIME OF DELIVERY : 23/02/2017

MODE OF DELIVERY ND with episiotomy

CONDITION OF BABY AT BIRTH Baby cried immediately after birrth

SEX OF BABY: Female

DISC NO OF MOTHER AND 212


BABY:
SUBJECTIVE DATA

PAST MEDICAL HISTORY : Nothing Significant

PAST SURGICAL HISTORY : Appendisectomy at the age of 16 years of


age.

PRESENT MEDICAL HISTORY : Nothing Significant

PRESENT SURGICAL HISTORY : Nothing Significant

OBJECTIVE DATA

PERSONAL HISTORY

EDUCATION : H.S.

OCCUATION : Housewife

INCOME : Family income

MARITAL STATUS : 2 years


ANY ADDICTION : Nil

DIET(ANY HARMFUL Non –veg .She takes adequate diet during


CULTURAL PRACTICES AFTER pregnancy . No harmful cultural practice
CHILD BIRTH): after child birth is present

SOCIAL HISTORY

CLASS AND SOCIAL STATUS : Lower middle

HOUSING CONDITION : Pucca

LIGHTING OR ELECTRICITY : Electricity

WATER SUPPLY : Tube well

SANITATION : Well

Latrine

FAMILY HISTORY

TYPE OF FAMILY : Joint Family

NUMBER OF DAILY MEMBER : 5

SUPPORT PERSON IN THE Husband


FAMILY

NUMBER OF CHILDREN : Primi

ANY FAMILY HERIDITARY : No history of diabetes. TB, Blood disorders


DISEASE and hypertension or both paternal and
maternal side.

MENSTRUAL HISTORY

AGE OF MENARCHY : 12 Years

DURATION : 4 days
CYCLE : 28 days  3 days

REGULAR OR EREGULAR : Regular

FLOW : Normal

ANY COMPLAIN : Nil

OBSTATIC HISTORY

PARITY : P0+0

GRAVIDA : Primi

HISTORY OF CHILD BIRTH : N.A.

ANY BAD OBSTETRIC HISTORY : Primi Gravida

L.M.P. : 17/5/2016

E.D.D. : 24/02/2017

TIME OF L.C.B. : Nil

DRUG ADDICTORY HISTORY

ANY DRUG OF FOOD ALERGY : Nil

REGULAR DRUG INTAKE : Nil

PHYSICAL ASSESSMENT DONE : DATE : 24/02/17 TIME : 9am

EMOTIONAL STATE
ANXIOUS (/X) : X

CALM (/X) : 

ANGRY (/X) : X

COOPERATIVE (/X) : Cooperative

FEARFUL (/X) : X

RESTLESS (/X) : X

WITHDRAW (/X) : X

CENTRAL NERVOUS SYSTEM

LEBEL OF CONSCIOUSNESS

ALERT (/X) : 

DROWSY (/X) : X

CONFUSED (/X) : X

SEMI CONCIOUS (/X) : X

COMATOSE (/X) : X

ORIENTED TO :

TIME (/X) : 

PLACE (/X) : 

PERSON (/X) : 

SPEECH

RELEVANT (/X) : 

IRRELEVENT (/X) : X

SLURRED (/X) : X
APHASIA (/X) : X

RESPIRATORY SYSTEM :

CHEST MOVEMENT :

UNILATERAL (/X) : X

BILATERAL (/X) : 

ABSENT (/X) : X

RESPIRATORY PATTERN :

NORMAL (/X) : 

DYSPHNOEA (/X) : X

OPTHOPNOEA (/X) : X

P.N.D. (/X) : X

TACHYPNOEA (/X) : X

DRADYPHNOEA (/X) : X

AIR-ENTRY :

BILATERAL EQUAL (/X) : 

DIMINISHED RIGHT (/X) : X

DIMINISHED LEFT (/X) : X

BIRTH SOUND :

NORMAL (/X) : 

RALE (/X) : X

RONCHI (/X) : X
WHEEZE (/X) : X

STRIDOR (/X) : X

COUGH :

PRESENT (/X) : X

ABSENT (/X) : 

PRODUCTIVE (/X) : X

NON-PRODUCTIVE (/X) : X

OXYGEN FLOW (Ltr./Min) : X

CARDIO-VASCULAR SYSTEM

PULSE

NORMAL (/X) :  82 b/m

TACHYARRYTHMIA (/X) : X

BRADYARRYTHMIA(/X) : X

BLOOD PRESSURE

NORMOTESNSION (/X) :  120/80 mm of Hg

HYPOTENSION (/X) : X

HYPERTENSION (/X) : X

PERIPHERAL PULSE

PRESENT (/X) : 

ABSENT (/X) : X

FEEBLE (/X) : X
REDIAL (/X) : 

POPLETIAL (/X) : 

POST TIBIAL (/X) : 

DORSALPEDIS (/X) : 

HEART SOUND

S1(/X) : 

S2(/X) : 

S3(/X) : X

S4(/X) : X

MURMUR (/X) : X

NECK VAIN DISTENION (/X) : X

CHEST PAIN (/X) : X

GASTRO-INTESTINAL SYSTEM

MOUTH

CLEAN (/X) : 

SORE (/X) : X

HALITOSIS (/X) : X
TEETH

CLEAN (/X) : 

PLAGUE (/X) : X

TONGUE (/X) : 

CLEAN (/X) : 

COATED (/X) : X

ORAL ULCER (/X) : X

PERISTOLSIS (/X) : 

ABDOMINAL DISTENTION (/X) : X

NAUSEA (/X) : X

VOMITING (/X) : X

N.B.M. (Specify time) (/X) : 

NUTRITIONAL ROUTE

ORAL (/X) : X

TUBE FEEDING (/X) : X

PARENTERAL (/X) : 

BOWEL OPEN

CONSTIPATION (/X) : X

DIARRHOEA (/X) : X

MALENA (/X) : X

GENITO-URENARY SYSTEM

VOID : X
FREELY (/X) : X

CATHETER (/X) 

URINE

CLEAR (/X) : 

SEDIMENT (/X) : X

HAEMATURIA (/X) : X

RETENTION (/X) : X

INCONTINENCE (/X) : X

NOT APPLICABLE (/X) : X

INTEGUMENTARY SYSTEM

SKIN

INTACT (/X) : 

BREAK DOWN (/X) : X

RASH (/X) : X

BLISTER (Mention specific site) : X


(/X)

CYANOSIS (/X) : X

PERIPHERAL (/X) : X

CENTRAL (/X) : X

PERIPHERIES :

WARM (/X) : 

COLD (/X) : X
NAIL-CLUBBING (/X) : X

CAPILARY REFIL (Less than 3 sec.) : 

OEDEMA (/X) : X(Legs)

HOMAN’S SIGN X

ICTERUS (/X) : X

TEMPERATURE

FEBRILE (/X) : X

AFEBRILE (/X) : 

PULSE (/X) : 

RESPIRATION (/X) : 

BLOOD PRESSURE (/X) : 

SCALP

PEDICULOSIS (/X) : X

DANDRUFF (/X) : X

RASH (/X) : X

EYE

CLEAN (/X) : 

DISCHARGE (/X) : X

NOSE

CLEAN (/X) : 

DISCHARGE (/X) : X

EAR
CLEAN (/X) : 

DISCHARGE (/X) : X

SLEEP

ADEQUATE (/X) : 

DISTURBANCE (Specify) (/X) : X

MUSCULO-SKELETAL SYSTEM

JOINT

MOBILE (/X) : 

STIFF (/X) : X

PAINFUL (/X) : X

CONTRACTURE (/X) : X

AMBULENT (/X) : 

BED RIDDEN (/X) : X

BED TO CHAIR OR TOILET (/X) : X

INVESIVE LINE

INCISIONAL WOUND (/X) : 

HEALTHY (/X) : 

OOZING (/X) : X

DRESSING (/X) : 

PAIN-RATING (1-10 Scale)

Obstetrical examination:
Inspection: No undue enlargement
Palpation of uterus: Uterus is soft and tender .Fundal height – 15 cm, subinvoluted .
(Consistency , shape and descent)
Per vaginal inspection / examination :
Vulval edema : Nil
Vagina : Copius discharge,
(Any vaginal bleeding , clots , warts / mole / infection / discharge )
Perineal area / anus: painful
(Intact , lacerations or haemorrhoids , any pain )
Inspect REEDA for episiotomy wound: Wound is redness and edematous .
(Redness , edema , ecchymosis , discharge and apposition )
Colour and amount of lochia odour: Lochia rubra present , copius Smell –offensive odor
Any complaints : Pain in episiotomy wound site

Laboratory reports:

Blood group: B Rh: Positive VDRL: Negative PPBS:Not done

Fasting: 71 mg/dl Hb%: 11.4 gm/dl Others: TSH :1.74mcg/dl

Urine :Sugar: Nil Albumin: Nil

USG report : Single living fetus , liquor –adequate , Placenta – posterior .

Delivery notes( from records):Normal delivery with mediolateral episiotomy done .A full term
living baby boy was born on 23/02/18 at 10.58 pm .Inj oxytocin 10 IU given .

Total duration of labour: 13 hours

Removal of placenta : Spontaneous√ /Manual

Treatment: Cap Amoxycillin 500 mg 1 cap TDS , Tab Brufen ,tab metrogyl , tab famotidine .

Received of mother at post natal ward at 11am On24/5/16.

BABY
Physical Examination Findings
Condition of the newborn :Good , posture-flexed ,well cried ,alert

Vital signs:
Colour of skin :Pink texture - soft smooth .Dryness over hands and feet .Good turgor .Vernix
present.
Heart rate (Apex bit):138 beats/ min
Respiration :40 breaths/ min
Physical measurement:
Weight:2.6 kg
Length :49 cm
Head circumference :34 cm
Chest circumference :31 cm

Head to foot examination:


Examination of head:
Frontanelles/sutures/caput: Anterior frontanelle dimond shaped , 2.5X3cm. No overriding of
suture .
No moulding.
Face: Normal
Eyes Clean and healthy .Sclera –white , iris – dark gray
Ears:Top of the pinna of ears is in a horizontal plane to the outer cantus .
Pinna is firm ,cartilage felt along with edge .Instant recoil .
Nose: Nasal passage is patent
Mouth:No precocious teeth , no epstain pearl , uvula in midline .No cleft lip or cleft palate .
Neck: Short .No gland is palpable .
Limbs and digits : 10 fingers of hands and toes each .Palmer creases present over 1/3rd portion .
Chests :Clear .
Breast:Breast tissue is more than 10 mm. Areola raised .
Abdomen: Soft .No palpable mass .
Umbilical cord: Umbilical cord is clean and no bleeding .2 arteries and 1 vein present .
Genitalia : Labia majora well developed and completely cover the labia minora .No discharge
.Urethral meatus is located above the vaginal orifice .
Anus: Patent.
Spine/back: Normal .
Hips(ortoloni’s test): No hip dislocation .
Legs: 10 fingers of toes and sole creases present over a 1/3rd portion .

Reflexes:
Grasp: Present .
Moro: Present .
Glabellar: Present .
Rooting: present .
Sucking: Present .
Planter and Babinski : Present .

Muscle activity: Normal .


Urine: Passed.
Meconium: Passed .
General impression : Baby is normal .
(Specify if any abnormalities found)
 INTRODUCTION :--
Puperium is the period following child birth during which the body tissues ,
especially the pelvic organs revert back approximately to the prepregnant state both
anatomically and physiologically .
Involution is the process where by the genital organs revert back approximately
to the state as they were before pregnancy ..
Puperium begins as soon as the placenta is expelled and lasts for
approximately 6 weeks when the uterus becomes regressed almost to the
nonpregnant size.
A rise of temperature reaching 100. 4 ⁰ F ( 38 ⁰C ) or more ( measured
orally ) on two separate occasions at 24 hours apart ( excluding first 24 hours )
within first 10 days following delivery is called puerperal pyrexia .

 CAUSES OF PUERPERAL PYREXIA :-


 Puerperal sepsis
 Urinary tract infections : Cystitis , Pyelonephritis
 Mastitis , breast abscess
 Wound infections : CS or Episiotomy
 Pulmonary infections : Atelectasis , Pneumonia
 Septic pelvic thrombophlebitis
 A recrudescence of malaria or pulmonary tuberculosis
 Others : Pharyngitis , Gastroenteritis .

PUERPERAL SEPSIS ( Syn:Puerperal infection )

 DEFINITION :- An infection of the genital tract which occurs as a complication


of delivery is termed puerperal sepsis . Puerperal pyrexia is considered to be due to
genital tract infection unless proved otherwise .

There has been marked decline in puerperal sepsis during the past few years due to:-

1) Improved obstetrics care


2) Availability of wider range of antibiotics

Puerperal sepsis is commonly due to _

i) Endometritis
ii) Endomyometritis
iii) Endoparametritis or a combination of all these when it is called pelvic cellulitis .
IN BOOK IN PATIENT
 PREDISPOSING FACTORS OF
PUERPERAL SEPSIS :-
The pathogenicity of the
vaginal flora may be influenced by
certain factors :-
1) The cervicovaginal mucous
membrane is damaged even in normal
delivery .
2) The uterine surface too , especially
the placental site , is converted into
an open wound by the cleavage of
the decidua which takes place during
the third stage of labor , and
3) The blood clots present at the
placental site are excellent media for
the growth of the bacteria .
 Antepartum risk factors :-
1) Malnutrition and anemia Predisposing factors of my mother is
2) Preterm labour Malnutrition and anemia
3) Premature rupture of the membranes
4) Immunocompromised (HIV) Premature rupture of the membranes
5) Prolonged ruptured of membrane more
than 18 hours ,
6) Diabetes
 Intrapartum risk factors :-
1) Repeated vaginal examinations .
2) Dehydration and ketoacidosis during Repeated vaginal examinations done in labour
labour room
3) Traumatic vaginal delivery
4) Haemorrhage --antepatum or postpartum ,
5) Retained bits of placental tissue or
membranes
6) Prolonged labour
7) Obstructed labour
8) Cesarean delivery
 Microorganisms responsible for puerperal sepsis and the major pathology
 Aerobic :- Group Aemolytic beta –hemolytic Streptococcus (GAS ) –Toxic shock
syndrome , necrotizing fasciitis in episiotomy or caesarean section wound .
 Others :- Staphylococcus pyogenes , S. Aureus , E . coli , Klebsiella , Pseudomonas ,
Proteus , Chlamydia .
 Anaerobic :- Streptococcus , Peptococcus , Bacteroides , Fusobacteria etc .
Most of the infections in the genital tract are polymicrobial with a mixture of
aerobic anaerobic organisms .
 MODE OF INFECTION :-
Puerperal sepsis is essentially a wound infection . Placental site ( being a raw
surface ) lacerations of the genital tract or caesarean section wounds may be infected
in the following ways :-

Source of infection may be endogenous where organisms are present in the genital tract
before delivery .

Infection may be autogenous where organisms present elsewhere ( skin , throat ) in the
body and migrate to the genital organs by bloodstream or by the patient herself .Beta –
hemolytic , Streptococcus , E.coli , Staphylococcus are important .

Infection may be exogenous where infection is contracted from sources outside the
patient . Beta –hemolytic , Streptococcus , Staphylococcus and E. Coli are important .

 PATHOLOGY :-
The primary sites of infection are :-
1) Perineum
2) Vagina
3) Cervix
4) Uterus

The infection is either localized to the site or spreads to distant sites . The lacerations on
the perineum , vagina and the cervix are often infected by the organisms due to the presence
of blood clots or dead space . The wound become red , swollen and there is associated
seropulent discharge . There may be disruptionof the if repaired before control of infection .
Diabetes , obesity , immunocompromised state (HIV) are the other high risk factors for wound
infection .

Endogenous

Bacterial infection Bacterial colonization

Exogenous
Endometrium (placental implantation site ) , cervical lacerated wound , vaginal wound or
perineal lacerated wound are the favourable sites for bacterial growth and multiplication .
The devitalized tissue , blood clots , foreign body ( retained cotton swabs ) , and surgical
trauma favour polymicrobial growth , proliferation and spread of infection . This ultimately
leads to metritis , parametritis and / or cellulitis .

 Uterus :- Endomyometritis :- It is commonly polymicrobial ( Group A or B


Sreptococci , clostridia ) . The decidua especially over the placental site is primarily
affected . The necrosed decidua sloughs off . The discharge is offensive .
 Pelvic cellutis ( parametritis ) is due to spread of infection to the pelvic cellular
tissues by direct or by lymphatic or hematogenous routes .
 Peritonitis :- It is common following infection after cesearean delivery . There may
be necrosis of uterine incision wound .
 Salphingitis :- It may be interstitial (due to lymphatic spread ) or perisalpingitis ( following
pelvic peritonitis ) ,Endosalpongitis ( tubal mucosa ) is uncommon .

Pelvic abscess following peritonitis may be due to spread of infection ------

a) Directly through the tubes


b) Lymphatic spread ,or
c) Brushing of parametrial abscess .
Rarely ,there may be generalized peritonitis . Pelvic abscess has become rare (1%) with the use
of antibiotics .
 Septic pelvic thrombophlebitis :- May involved the ovarian veins , uterine veins , pelvic veins
and rarely inferior vena cava . The infected thrombus may under go complete resolution or
suppuration . At times emboli may occlude the microcirculation of the vital organs like lungs
or kidney .
 Septicemia and septic shock :- May be due to haemolytic Streptococci (Streptococcal toxic
shock syndrome ) or anaearobic Streptococci . Septicemia may cause lung abscess , meningitis
, pericarditis ,endocarditis or multi organ failure . Death occurs in about 30% of cases .
In book In patient
 CLINICAL FEATURES :-
 Local infection
 Uterine infection
 Spreading infection

 Local infection ( Wound infection ) :-


1) There is slight rise of temperature , generalized malaise or headache ,
slight rise of
2) The local wound becomes red and swollen , temperature
3) Pus may form which leads to disruption of the wound , there is rise of
temperature with chills and rigor .

 Uterine infection :-
MILD :-
1) There is rise of temperature (> 100.4 ₒ F ) and pulse rate (>90) ,
2) Lochial discharge becomes offensive and copious ,
3) The uterus is subinvoluted and tender . Lochial discharge becomes
SEVERE :- offensive and copious ,
1) The onset is acute with high rise of temperature , often with chills and
Fundal height is 15 cm
rigor . The uterus is
2) Pulse rate is rapid , out of proportion to temperature , subinvoluted and
3) Often there is breathlessness , coughs , abdominal pain and dysuria , tender
4) Lochia may be scanty and odourless ,
5) Uterus may be subinvoluted , tender and softer .
6) There may be associated wound infection ( perineum , vagina or the cervix
).

 Spreading infection ( Extra uterine spread ) :-


It is evident by presence of pelvic tenderness ( pelvic peritonitis ) ,
tenderness on the fornix (parametritis ) , bulging fluctuant mass in the pouch of
Doulas ( pelvic abscess ) .
 Parametritis :- The onset is usually about 7 to 10 th day of puerperium .
parametritis
In book In patient
o Constant pelvic pain
o Tenderness on either side of the hypogastrium , Pain present
o Vaginal examination reveals a unilateral indurated mass pushing the
uterus to the contralatteral side .
o Rectal examination confirms the induration especially extending along the
uterosacral ligament .
o If , however , suppuration occurs , the features are :-
o Steady rise of spiky temperature with chills and rigor
o Intense pain
o Gradual deterioration of the general condition
 Pelvic peritonitis :-
Pyrexia
o Pyrexia with increase in pulse rate ,
Temperature-1020 F
o Lower abdominal pain and tenderness , muscle guard may be absent .
o Vaginal examination reveals tenderness on the fornix and with the
movement of the cervix ,
o Collection of pus in the pouch of Douglas is evidenced by swinging
temperature , diarrhea and a bulging fluctuant mass felt through the
posterior fornix .
 General peritonitis :-
o High fever with a rapid pulse
o Vomiting
o Generalised abdominal pain
o Patient looks very ill and dehydrated
o Abdomen is tender and distended . Rebound tenderness is often present .
 Thrombophebitis :-
o The clinical features of pelvic thrombophlebitis are similar to those of
uterine infection or parametritis ,
o There may be swinging temperature continued for a longer period with
chills and rigor ,
o The features of pyemia are present according to the organs involved .
 Septicemia :-
o There is high rise of temperature usually associated with rigor . Pulse rate
is usually rapid even after the temperature settle down to normal ,
 Blood culture is positive
o Symptoms and signs of metastatic infection in the lungs , meninges or
joints may appear .
 Bacteremia , endotoxic or septic shock :-
It is manifested by hypotention , Oliguria and adult respiratory distress
syndrome .
IN BOOK IN PATIENT

 INVESTIGATION OF PUERPERAL SEPSIS :-


HISTORY
 Principles in investigations are :-
 To locate the site of infection
 To identify the organisms Antenatal ,
 To assess the severity of the disease . intranatal and
 History :- Antenatal , intranatal and postnatal history of any high risk
postnatal history
factor for infection like anaemia , prolonged rupture of membranes or Malnutrition and
prolonged labour are to be taken . anaemia (Hb-
 Clinical examination :- 9.4mg/dl)present
It includes through general , physical and systemic
examinations . Abdominal and pelvic examinations are done to note the
evaluation of genital organs and locate the specific site of infection .
Legs should be examined for thrombophlebitis or thrombosis .
 Investigation include :-
 High vaginal and endocervical swabs for culture and sensitivity . Sent vaginal swab
 Clean catch mid stream specimen of urine for analysis and culture,Urine for
culture and sensitivity . analysis and
 BLOOD for HB, TC and DC , Thick blood film for Malaria Parasites .
culture and
 Pelvic Ultrasound to detect any retained bits of conception within the sensitivity,
uterus , to locate any abscess with the pelvis , and collecting samplesblood
fromfor HB%,
the pelvis . TC, DC, ESR to
 CT scan and MRI . pathology
 X –ray chest should be taken in cases with suspected pulmonary Koch’s
lesion
 Blood urea and electrolytes if renal failure develop later .

PROPHYLAXIS :- Puerperal sepsis is to a great preventable


provided certain measures are undertaken , before , during and
following labour .
Antenatal prophylaxis includes improvement of nutritional status ( to raise
haemoglobin level ) of the pregnant woman and eradication of any septic focus
skin , throat ,tonsils ) .
Intranatal prophylaxis includes :-
 Full surgical asepsis during delivery
 Screening for group B streptococcus in a high risk patient .
 Prophylactic use of antibiotic is not recommended as a routine .
 Prophylactic use of antibiotic at the time of caesarean section has
IN BOOK IN PATIENT

significantly reduced the incidence of wound infection , endometritis , urinary tract


infection and other serious infections . Inj. Cetriaxone 1gm I.V. immediately after
cord clamping and a second dose after 8 hours is recommended .
 Postpartum prophylaxis includes aseptic precautions for at least one week
following delivery until the open wounds in the uterus , perineum , vagina are
healed up .
 Too many visitors are restricted .
 Sterilized sanitary pads are to be used .
 Infected babies and mothers should be in isolated room .

 TREATMENT :-
General care :- Isolation of the
 Isolation of the patient is preferred specially when haemolytic patient
streptococcus is obtained on culture .
 Adequate fluid and calorie is supplied if needed by intravenous Adequate fluid and
infusion. calorie is supplied
 Anaemia is corrected by oral iron and if needed by blood
transfusion .
 Pain is relieved by adequate analgesia . Anaemia is
 An indwelling catheter is used to relieve any urine retention corrected by oral
due to pelvic abscess. It also help to record urinary output, iron
 A chart is maintained by recording pulse, respiration, temperature,
lochial discharge, and fluid intake and output. Pain is relieved by
 Antibiotics :- Depend on the culture and sensitivity report adequate analgesia
pending the report,
 Inj. Gentamicine (2mg / kg IV loading dose, followed by 1.5mg / PCM 1 Tab TDS
kg IV every 8 hours ) and
 Inj. clindamycin ( 900mg IV every 8 hours) should be started . A chart is
 Inj. Metronidazole 0.5 g.IV is given at 8 hours interval tocontrol the maintained by
anaerobic group . recording pulse,
 The treatment is continued until the infection is controlled for respiration,
atleast 7 – 10 days. temperature,
 In case of severe sepsis :- lochial discharge,
 A combination of either piperacillin – tazobactam or carbapenem and fluid intake
puls clindamycin has broadest range of antimicrobial coverage . and output.
IN BOOK
IN PATIENT
SURGICAL TREATMENT : there is little role of major surgery
in the treatment of puerperal sepsis. NO NEED
 Perineal wound – the stitches of the perineal wound may have
to be removed to facilitate drainage of pus and relieve pain. The
wound is to be cleaned with sitz bath several times a day and is
dressed with an antiseptic ointment or powder. After the
infection is controlled, secondary suture may be given.
 Retained uterine products with a diameter of 3 cm or less may
be disregarded and left alone. Otherwise surgical evacuation
after antibiotic coverage for 24 hours should be done to avoid the
risk of septicemia. Cases with septic pelvic thrombophlebitis are
treated with IV heparin for for 7- 10 days.
 Pelvic abscess should be drained by colostomy under
theultrasound guidance.
 Wound dehiscence :-
Dehiscence of episiotomy or abdominal wound following
cesarean sectionis maintained by scrubbing the wound twice
daily, debridment of all necrotic tissue and then closing the
wound with secondary suture. Appropriate antimicrobials are
used following culture and sensitivity .
 Laparotomy has got limited indications .
 Maintenance of electrolytic balance by intravenous fluid along
with appropriated antibiotic therapy usually controls the
peritonitis . However, in unresponsive peritonitis, lapatomy is
indicated.
 If no palpable pathology is found, drainage of pus may be
effective.
 Hysterectomy:-
It is indicated in case with rupture or perforation, having
multiple abscesses, gangrenous uterus or gas gangrene infection .
Ruptured tubo – ovarian abscess should be removed .
IN BOOK IN PATIENT

 Necrotizing fascilitis :-
Is rare but fatal complication of wound infection
(abdominal , perineal , vaginal ), involving muscles and fascia.
 Risk factors are diabetes , obesity and hypertension.
 Infection is caused by Group A hemolytic streptococcus
and often it is polymicrobial. Tissue necrosis is the
significant pathology.
 Treatement includes: rehydration wound scrubbing
,debridement of all necrotic tissues, and use of high dose
broad – spectrum(IV)antibiotics.
 Indication of intensive caree management:
 Hypotension.
 Oliguruia .
 Raised serum creatinine.
 Rised serum lactate
 Thrombocytopenia ,
 ARDS,
 Hypothermia .
 Management of bacteremic or septic shock :-
o Fluid and electrolyte balance (to monitor CVP),
o Respiratory supports (to maintain arterial PO2 and
PCO2),
o Circulatory support (dopamine or dobutamine),
o Infection control (intensive antibiotic therapy, surgical
removal of septic foci) and septic management ( as
haemodialysis for renal failure) .

 NURSING MANAGEMENT :-
Assessment :-
 Elevation in temperature to 100.4⁰ F or above with chills
 Foul smelling lochia
 Abdominal tenderness and pelvic pain
 Pain and burning sensation during micturation
 Tachycardia
 Increased white blood cells (WBCs )
 Presence of predisposing factors
 Traumatic birth
 Prolonged difficult labour , Prolonged ruptured of membranes\
 Excessive vaginal discharge
 Anemia
 Retained placentral fragment
 Hemorrhage
 Mother is dehydrated , frustrated due to extreme fatigue .

Nursing care plan on 24/2/18:-

Nursing Diagnosis Expected Planning Implementation Evaluation


outcome
Pyrexia related to Body *General condition *Assessed the general Body temperature
disease process . temperature should be assessed. condition is normal
should be *vital signs should be *vital signs are checked Temp-37.50 c
normalized.. checked
*antibiotics should be *Antibiotics ceftriaxone is
administered as doctor’s given I/V as per doctor’s
advice advice
*Antipyuretics should be * Antipyuretics should be
administered as doctor’s administered as doctor’s
advice advice

*aseptic technique should


be maintained upto six *Aseptic technique is
weeks maintained
*Cleanliness with
personal hygiene should *Cleanliness is maintained
be maintained
*tepid sponge should be
given *Tepid sponge is provided

Pain in lower Pain should *Mother should be *Mother should be Pain is slightly
abdomen related to be assessed assessed. assessed. reduced
growth of organism *emotional support *Emotional support is
in uterus as should be given given
evidenced by mother *antibiotics should be *antibiotics should be
verbalises administered as doctor’s administered as doctor’s
advice advice
*Antipyuretics should be *Antipyuretics should be
administered as doctor’s administered as doctor’s
advice advice
*aseptic technique should *aseptic technique should
be maintained upto six be maintained upto six
weeks weeks
Nursing Diagnosis Expected Planning Implementation Evaluation
outcome
Fatigue related to Fatigue will *Mother should be *Mother is assessed Mother understands
disease process as be reduced. assessed and takes food.
evidenced by Lack
of interest to take *Mother should be *Mother is encouraged to
food, tierd, lack of encouraged to take food take food
sleep.
*Mother should be *Mother is informed about
informed about the the disease process.
disease process.

*Divertional therapy *Divertional therapy


should be administered. should be administered.

*Calm and quiet


environment should be *Calm and quiet
provided. environment is provided.

*Emotional support *Emotional support is


should be given. given.

Disturbed sleeping Sleeping *Sleeping pattern of *Sleeping pattern of Sleeping pattern is


pattern related to pattern will mother should be mother is observed. improved.
anxiety for be observed.
illness/nausea and improved.
vomiting as *Emotional support *Emotional support is
evidenced by mother should be given. given.
verbalizes.
*Divertional terapy *Divertional therapy is
should be provided. provided.

*Antiemetic drugs should *Antiemetic drugs is


be administered as per administered as per
doctors advise. doctors advise.

*Calm and quiet *Calm and quiet


environment should be environment is provided.
provided.
Nursing Expected Planning Nursing intervention Evaluation
Diagnosis outcome
Risk for fluid Fluid *Patient should be - The name of patient, blood No blood
volume, volume assessed group, bottle no. and date of transfusion
excess will be in expiry are checked before reaction is
related to normal *Breath sound should be starting blood transfusion. arising. The
blood limit. checked . patient is quite
transfusion -The breath sound is checked and calm.
frequently for Crepitus. No muffling is
*Vital signs should be -The vital sign are checked ½ heard.
checked hourly. Urinary output
-Observed for any reaction is normal.
*patient should be occur. T-97.2°F
observed -Reassurance is given to the P-88b/min
*Emotional support patient. R-26/min
should be given Dyspnea is
relieved.
The blood
Risk for Adequate - o2 inhalation as ordered -Provided o2 inhalation as sample is sent.
Ineffective tissue should be Provided . ordered.
tissue perfusion - The head end is elevated - The head end is elevated 30° to
perfusion and 30° to decrease dyspnea decrease dyspnea and
related to CRT<3sec. and discomfort. discomfort.
decrease o2 - Vital sign should be - Vital sign are checked 4 hourly.
supply as checked 4 hourly.
evidenced by - chest pain and -Investigated for chest pain and
CRT>3sec., palpitation should be palpitation.
dypnea and investigated.
Hb-4.6gm%. -Blood sample should be -Blood sample is sent for Hb%,
sent for Hb%, and and hemocrit level.
hemocrit level. -Collaborated with health care
- health care team team members regarding
members regarding frequency of laboratory test.
frequency of laboratory
test should be
Collaborated .
Imbalance The patient High protein diet should -The patient is advised for high
nutrition less will be provided iron and high protein diet e.g. Today she has
than body maintain -The daily body weight is liver, egg. deep green leafy taken high iron
requirement good taken with a same vegetables, milk, meat, fish, and protein diet.
related to physical machine. soyabean, fig, jiggery etc.
disease condition
process as and fetus -Intake and output chart is -The daily body weight is taken
evidenced by will gain maintained. with a same machine.
pallor and weight.
poor physical -Advised to chew the food -Intake and output chart is
condition properly before maintained.
and USG swallowing to avoid
revealed indigestion. -Advised to chew the food
IUGR. -Advised to avoid extra properly before swallowing to
salt adding in food. avoid indigestion.
-Advised to avoid extra salt
adding in food.

Nursing care process for baby on 24/2/18

Nursing diagnosis Goal Planning Expected outcome


1.Ineffective thermoregulation Adequate body Kept infant warm with mother . Baby’s body
related to heat loss from temperature . Wrapped the baby in a baby temperature is normal.
exposure in postnatal ward . sheet covering the head and
extremities .
Baby is kept clean and dry after
urination and passing after
meconium.
Potential risk for ineffective Establish Mother is advised regarding the
airway due to pressure of breathing Baby is crying
risk .
mother’s breast and baby’s effectively . .Respiration is normal.
Support person is informed.
blanket .
Baby is kept under close
observation .

Potential risk for infection No sign of Strict aseptic technique is


related to newly clamped No sign of infection .
infection . maintained while handling the
umbilical cord and exposure to baby .
eyes to vaginal secretions .
Eyes are cleaned with sterile
swabs.
Cord is checked for dry
gangrene .

Impaired nutrition less than Unaltered Breastfeeding :Initiated with Baby is active and
body requirement related to nutritional status . colostrum . passed urine .
newborn’s transition to Baby is sucking breast milk
extrauterine life . properly .
Checked passage of urine .
Checked baby’s body weight .

Checked passage of urine .


Checked passage of meconium .

Impaired elimination pattern Normal Baby has passed urine


A thorough physical
related to newborn’s transition to elimination and meconium.
examination done .
extrauterine life . pattern .
All physical parameters
checked .
All reflexes checked .
Potential risk for congenital Early diagnosis of Helped to allay anxiety related Nothing abnormalities
anomalies or any abnormality . any abnormality to sex . found .
or anomalies . Taught parenting , baby holding
, baby care , provided support
system.
Parents will Advised given focusing on
Potential risk for ineffective Demonstrates positive
accept the role of normal newborn’s problems
parenting related to sex of baby . parenting behaviour.
parent . regarding :
Normal’s normal behaviour and
abnormal one , eg-sleep pattern
, breathing , condition and
colour of skin , crying ,
elimination .
Health seeking behaviours Demonstrate Stabilization .
Parents asked more
related to needs of a normal positive parenting Exclusive brastfeeding for 6
questions and clarifies
newborn during hospital and behaviour . months.
their doubts regarding
after discharge from the hospital Activity/ hygiene /clothing .
baby care .
. Adequate bonding Safety / sequrity / bonding .
. Immunization schedule : Inj
BCG and hep and ‘0’ dose
polio given at hospital .Advised
to continue rest of the schedule
in time .
Follow up attendance at well
baby clinic.

Nursing care plan on 25/2/18:-

Nursing Expected Planning Implementation Evaluation


Diagnosis outcome
Pyrexia related Body *General condition should be *Assessed the general Body
to disease temperature assessed. condition temperature
process . should be *vital signs should be checked *vital signs are checked is normal
normalized.. *antibiotics should be Temp-37.50
administered as doctor’s advice *Antibiotics ceftriaxone is c
*Antipyuretics should be given I/V as per doctor’s
administered as doctor’s advice advice
* Antipyuretics should be
*aseptic technique should be administered as doctor’s
maintained upto six weeks advice
*Cleanliness with personal
hygiene should be maintained
*tepid sponge should be given *Aseptic technique is
maintained

*Cleanliness is maintained
*Tepid sponge is provided
Pain in lower Pain should be *Mother should be assessed. *Mother should be assessed. Pain is
abdomen related assessed *emotional support should be *Emotional support is given slightly
to growth of given *antibiotics should be reduced
organism in *antibiotics should be administered as doctor’s
uterus as administered as doctor’s advice advice
evidenced by *Antipyuretics should be *Antipyuretics should be
mother administered as doctor’s advice administered as doctor’s
verbalises *aseptic technique should be advice
maintained upto six weeks *aseptic technique should be
maintained upto six weeks

Nursing Expected Planning Implementation Evaluation


Diagnosis outcome
Fatigue related to Fatigue will be *Mother should be assessed *Mother is assessed Mother
disease process reduced. understands
as evidenced by *Mother should be encouraged and takes
Lack of interest to take food *Mother is encouraged to food.
to take food, take food
tierd, lack of *Mother should be informed
sleep. about the disease process. *Mother is informed about
the disease process.
*Divertional therapy should be
administered.
*Divertional therapy should
*Calm and quiet environment be administered.
should be provided.

*Emotional support should be *Calm and quiet


given. environment is provided.

*Emotional support is given.

Disturbed Sleeping pattern *Sleeping pattern of mother *Sleeping pattern of mother Sleeping
sleeping pattern will be should be observed. is observed. pattern is
related to anxiety improved. improved.
for illness/nausea *Emotional support should be
and vomiting as given. *Emotional support is given.
evidenced by
mother *Divertional terapy should be *Divertional therapy is
verbalizes. provided. provided.

*Antiemetic drugs should be *Antiemetic drugs is


administered as per doctors administered as per doctors
advise. advise.

*Calm and quiet environment *Calm and quiet


should be provided. environment is provided.
Nursing Expected Planning Nursing intervention Evaluation
Diagnosis outcome
Risk for fluid Fluid *Patient should be - The name of patient, blood No blood
volume, volume assessed group, bottle no. and date of transfusion
excess will be in expiry are checked before reaction is
related to normal *Breath sound should be starting blood transfusion. arising. The
blood limit. checked . patient is quite
transfusion -The breath sound is checked and calm.
frequently for Crepitus. No muffling is
*Vital signs should be -The vital sign are checked ½ heard.
checked hourly. Urinary output
-Observed for any reaction is normal.
*patient should be occur. T-97.2°F
observed -Reassurance is given to the P-88b/min
*Emotional support patient. R-26/min
should be given

Risk for Adequate - o2 inhalation as ordered -Provided o2 inhalation as Dyspnea is


Ineffective tissue should be Provided . ordered. relieved.
tissue perfusion - The head end is elevated - The head end is elevated 30° to The blood
perfusion and 30° to decrease dyspnea decrease dyspnea and sample is sent.
related to CRT<3sec. and discomfort. discomfort.
decrease o2 - Vital sign should be - Vital sign are checked 4 hourly.
supply as checked 4 hourly.
evidenced by - chest pain and -Investigated for chest pain and
CRT>3sec., palpitation should be palpitation.
dypnea and investigated.
Hb-4.6gm%. -Blood sample should be -Blood sample is sent for Hb%,
sent for Hb%, and and hemocrit level.
hemocrit level. -Collaborated with health care
- team members regarding
frequency of laboratory test.
-

Nursing care process for baby on 25/2/18


Nursing diagnosis Goal Planning Expected outcome
1.Ineffective thermoregulation Adequate body Kept infant warm with mother . Baby’s body
related to heat loss from temperature . Wrapped the baby in a baby temperature is normal.
exposure in postnatal ward . sheet covering the head and
extremities .
Baby is kept clean and dry after
urination and passing after
meconium.
Potential risk for ineffective Establish Mother is advised regarding the
airway due to pressure of breathing Baby is crying
risk .
mother’s breast and baby’s effectively . .Respiration is normal.
Support person is informed.
blanket .
Baby is kept under close
observation .

Potential risk for infection No sign of Strict aseptic technique is


related to newly clamped No sign of infection .
infection . maintained while handling the
umbilical cord and exposure to baby .
eyes to vaginal secretions .
Eyes are cleaned with sterile
swabs.
Cord is checked for dry
gangrene .

Impaired nutrition less than Unaltered Breastfeeding :Initiated with Baby is active and
body requirement related to nutritional status . colostrum . passed urine .
newborn’s transition to Baby is sucking breast milk
extrauterine life . properly .
Checked passage of urine .
Checked baby’s body weight .

Checked passage of urine .


Checked passage of meconium .
Impaired elimination pattern Normal Baby has passed urine
A thorough physical
related to newborn’s transition to elimination and meconium.
examination done .
extrauterine life . pattern .
All physical parameters
checked .
All reflexes checked .
Potential risk for congenital Early diagnosis of Helped to allay anxiety related
anomalies or any abnormality . any abnormality Nothing abnormalities
to sex . found .
or anomalies . Taught parenting , baby holding
, baby care , provided support
system.
Potential risk for ineffective Parents will Advised given focusing on
parenting related to sex of baby . accept the role of normal newborn’s problems Demonstrates positive
parent . regarding : parenting behaviour.
Normal’s normal behaviour and
abnormal one , eg-sleep pattern
, breathing , condition and
colour of skin , crying ,
elimination .
Health seeking behaviours Demonstrate Stabilization .
related to needs of a normal positive parenting Exclusive brastfeeding for 6 Parents asked more
newborn during hospital and months. questions and clarifies
after discharge from the hospital behaviour . Activity/ hygiene /clothing . their doubts regarding
. Safety / sequrity / bonding . baby care .
Adequate bonding Immunization schedule : Inj
. BCG and hep and ‘0’ dose
polio given at hospital .Advised
to continue rest of the schedule
in time .
Follow up attendance at well
baby clinic.

Nursing care plan on 26/2/18:-

Nursing Expected Planning Implementation Evaluation


Diagnosis outcome
Pyrexia related Body *General condition should be *Assessed the general Body
to disease temperature assessed. condition temperature
process . should be is normal
normalized.. *vital signs should be checked *vital signs are checked Temp-37.50
c
*antibiotics should be *Antibiotics ceftriaxone is
administered as doctor’s advice given I/V as per doctor’s
advice
*Antipyuretics should be * Antipyuretics should be
administered as doctor’s advice administered as doctor’s
advice
*aseptic technique should be *Aseptic technique is
maintained upto six weeks maintained

*Cleanliness with personal *Cleanliness is maintained


hygiene should be maintained

*tepid sponge should be given *Tepid sponge is provided

Pain in lower Pain should be *Mother should be assessed. *Mother should be assessed. Pain is
abdomen related assessed slightly
to growth of *emotional support should be *Emotional support is given reduced
organism in given
uterus as
evidenced by *antibiotics should be
mother *antibiotics should be administered as doctor’s
verbalises administered as doctor’s advice advice

*Antipyuretics should be *Antipyuretics should be


administered as doctor’s advice administered as doctor’s
advice

*aseptic technique should be *aseptic technique should be


maintained upto six weeks maintained upto six weeks

Nursing Expected Planning Implementation Evaluation


Diagnosis outcome
Fatigue related to Fatigue will be *Mother should be assessed *Mother is assessed Mother
disease process reduced. understands
as evidenced by *Mother should be encouraged and takes
Lack of interest to take food *Mother is encouraged to food.
to take food, take food
tierd, lack of *Mother should be informed
sleep. about the disease process. *Mother is informed about
the disease process.
*Divertional therapy should be
administered.
*Divertional therapy should
*Calm and quiet environment be administered.
should be provided.

*Emotional support should be *Calm and quiet


given. environment is provided.

*Emotional support is given.

Disturbed Sleeping pattern *Sleeping pattern of mother *Sleeping pattern of mother Sleeping
sleeping pattern will be should be observed. is observed. pattern is
related to anxiety improved. improved.
for illness/nausea *Emotional support should be
and vomiting as given. *Emotional support is given.
evidenced by
mother *Divertional terapy should be *Divertional therapy is
verbalizes. provided. provided.

*Antiemetic drugs should be *Antiemetic drugs is


administered as per doctors administered as per doctors
advise. advise.

*Calm and quiet environment *Calm and quiet


should be provided. environment is provided.
Nursing Expected Planning Nursing intervention Evaluation
Diagnosis outcome
Risk for fluid Fluid *Patient should be - The name of patient, blood No blood
volume, volume assessed group, bottle no. and date of transfusion
excess will be in expiry are checked before reaction is
related to normal *Breath sound should be starting blood transfusion. arising. The
blood limit. checked . patient is quite
transfusion -The breath sound is checked and calm.
frequently for Crepitus. No muffling is
*Vital signs should be -The vital sign are checked ½ heard.
checked hourly. Urinary output
-Observed for any reaction is normal.
*patient should be occur. T-97.2°F
observed -Reassurance is given to the P-88b/min
*Emotional support patient. R-26/min
should be given

Risk for Adequate - o2 inhalation as ordered -Provided o2 inhalation as Dyspnea is


Ineffective tissue should be Provided . ordered. relieved.
tissue perfusion - The head end is elevated - The head end is elevated 30° to The blood
perfusion and 30° to decrease dyspnea decrease dyspnea and sample is sent.
related to CRT<3sec. and discomfort. discomfort.
decrease o2 - Vital sign should be - Vital sign are checked 4 hourly.
supply as checked 4 hourly.
evidenced by - chest pain and -Investigated for chest pain and
CRT>3sec., palpitation should be palpitation.
dypnea and investigated.
Hb-4.6gm%. -Blood sample should be -Blood sample is sent for Hb%,
sent for Hb%, and and hemocrit level.
hemocrit level. -Collaborated with health care
- team members regarding
frequency of laboratory test.
-

Nursing care process for baby on 26/2/18


Nursing diagnosis Goal Planning Expected outcome
1.Ineffective thermoregulation Adequate body Kept infant warm with mother . Baby’s body
related to heat loss from temperature . Wrapped the baby in a baby temperature is normal.
exposure in postnatal ward . sheet covering the head and
extremities .
Baby is kept clean and dry after
urination and passing after
meconium.
Potential risk for ineffective Establish Mother is advised regarding the
airway due to pressure of breathing Baby is crying
risk .
mother’s breast and baby’s effectively . .Respiration is normal.
Support person is informed.
blanket .
Baby is kept under close
observation .

Potential risk for infection No sign of Strict aseptic technique is


related to newly clamped No sign of infection .
infection . maintained while handling the
umbilical cord and exposure to baby .
eyes to vaginal secretions .
Eyes are cleaned with sterile
swabs.
Cord is checked for dry
gangrene .

Impaired nutrition less than Unaltered Breastfeeding :Initiated with Baby is active and
body requirement related to nutritional status . colostrum . passed urine .
newborn’s transition to Baby is sucking breast milk
extrauterine life . properly .
Checked passage of urine .
Checked baby’s body weight .

Checked passage of urine .


Checked passage of meconium .
Impaired elimination pattern Normal Baby has passed urine
A thorough physical
related to newborn’s transition to elimination and meconium.
examination done .
extrauterine life . pattern .
All physical parameters
checked .
All reflexes checked .
Potential risk for congenital Early diagnosis of Helped to allay anxiety related
anomalies or any abnormality . any abnormality Nothing abnormalities
to sex . found .
or anomalies . Taught parenting , baby holding
, baby care , provided support
system.
Potential risk for ineffective Parents will Advised given focusing on
parenting related to sex of baby . accept the role of normal newborn’s problems Demonstrates positive
parent . regarding : parenting behaviour.
Normal’s normal behaviour and
abnormal one , eg-sleep pattern
, breathing , condition and
colour of skin , crying ,
elimination .
Health seeking behaviours Demonstrate Stabilization .
related to needs of a normal positive parenting Exclusive brastfeeding for 6 Parents asked more
newborn during hospital and months. questions and clarifies
after discharge from the hospital behaviour . Activity/ hygiene /clothing . their doubts regarding
. Safety / sequrity / bonding . baby care .
Adequate bonding Immunization schedule : Inj
. BCG and hep and ‘0’ dose
polio given at hospital .Advised
to continue rest of the schedule
in time .
Follow up attendance at well
baby clinic.

PROGRESS REPORT
Day – 1 (24/02/18) Day – 2 (25/02/18) Day – 3 (26/02/18)

General condition:- Good General condition:- Poor General condition:-


B.P :- 110/80 mm\hg B.P :- 110/80 mm\hg Better than previous day
Temperature :- 102°F Temperature :- 99°F B.P :- 110/80 mm\hg
Pulse :- 90 bts/Min Pulse :- 100 bts/Min Pulse :- 84 bts/Min
Respiration :- 18 brs/Min Respiration :- 24 brs/Min Respiration:22 brs/Min
Intake :- NPM Urine :- 600 ml Temperature :- 98°F
Out put :- Urine passed Stool :- not passed Intake Out put :-
Level of consciousness:- Intake Out put :- 1400 1500 ml & 1400 ml
conscious ml & 1500 ml Level of
Stool :- passed Level of consciousness:- consciousness:-
Urine :- passed Conscious Conscious
Emotional status :- atert but Examination status:-
anxious Bleeding status:- copious Tense & anxious
Uterus: fundal height-15 cm discharge, offensive smell Urine :- Passed
Soft, tender Uterus: fundal height-15 Stool :- Not passed
cm, Soft, tender Bleeding status:-
copious discharge,
offensive smell
Uterus: fundal height-
15 cm, Soft, tender
RESEARCH ARTICLES

Jayasree Vanukuru,Rashmi Bagga ,Tanuja Muthyala et al “A clinical and microbiological study


of puerperal sepsis in a tertiary care hospital in India”This prospective study was carried out to
evaluate the clinical profile and bacterial isolates among women with puerperal sepsis in a
tertiary hospital in North India. Women with puerperal sepsis (n = 45) admitted from January
2015 to April 2016 were followed prospectively. Cultures were obtained from cervix, blood,
urine, and pyoperitoneum. Initial antibiotics were cefotaxime or piperacillin with tazobactam
plus amikacin plus clindamycin or metronidazole and were changed according to sensitivity.Out
of 7887 deliveries during this period, 45 (0.2%) women had puerperal sepsis. 16 (35.5%)
delivered in the present hospital, 25 (55.5%) at another health care facility, and 4 (8.9%) at
home. Delivery was by cesarean section (CS) in 24/45 (53.3%) and vaginal in 21/45 (46.6%).
Grade 1 sepsis occurred in 21, grade 2 in two, and grade 3 in 22 women. Majority (29/45 or
64.5%) had no risk factor for puerperal sepsis. There were two (4.4%) deaths and 13/45 (28.8%)
had near-miss morbidity. Pathogenic bacteria were isolated in 33/45 (73.3%) in cervical swab
(69%), blood, urine, or pus culture with no significant difference in the bacterial yield or species
isolated between cotton or polyester swabs (p > .05). Escherichia coli were the commonest
isolate and was sensitive to amikacin in all. Five had stillbirths and 4/40 neonates developed
sepsis but recovered. They concluded that Escherichia coli was the commonest pathogen and
was uniformly sensitive to amikacin, which may be included among the initial antibiotics to treat
puerperal sepsis in India.

REFERENCES

1. Dutta, D.C. Text Book of Obstetrics; ( 7th edition ); 2010;Kolkata;New Central Book
Agency Private Limited; page no 144-57.

2. Jacab, Annamma ; A comprehensive text book of Midwifery ; (2nd edition); 2005;


Kolkata; Joypee Brothers Medical publishers p. ltd;page no.103-17

3. Thaesyamma,c.p;A guide for midwifery students ;(1st edition);2008; Kolkata;J . P


Brothers medical publishers pvt.ltd.page no.94-108

4. Dawn,cs.Text Book of Obstetrics and neonatology (16th edition);2004;Kolkata; Indian


collage of maternal and child health, page no 98-105

5. Raman A.V, Maternity Nursing; 19th edition;2014; New Delhi , Wolters Kluwer (India)
Pvt. Ltd.,page no.414-429
RESEARCH AARTICLES

Available from: https://doi.org/10.1080/14767058.2017.1421933