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 postpartum

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 oC) 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 Curettage ( retained placenta)

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

3. Extension

via uterine wall Endometritis Myometritis Perimetritis Parametritis

4.

Extension via Lymphatic Limphangitis Perilimphangitis Parametritis Perimetritis

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.

(V.C. = inferior vena cava)

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