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Puerperal Disorders:
1. Puerperal Pyrexia.
2. 2ry Postpartum Hemorrhage.
3. Thrombo embolism.
4. Perineal Complications.
5. Bladder Dysfunction.
6. Bowel Dysfunction.
Puerperal Pyrexia
Definition:
a temperature of 380C or > , lasts for 2 days
or > in the first 10 days postpartum,
exclusive of the first 24h.
(puerperal sepsis)
Incidence: 3%
7% of all direct maternal deaths , excluding
deaths after abortion.
Etiology:
Puerperal infection is usually poly microbial
involves contaminants from the bowel
that colonize the perineum and
lower genital tract.
The most frequently identified organisms are :
1. instrumental delivery.
2. internal fetal monitoring.
3. multiple vaginal examinations.
4. prolonged ROM and chorioamnonitis.
5. cervical cerclage.
6. Non obstetric :
.. DM.
.. HIV.
Clinical Picture
Prevention:
1. awareness of general hygiene principles.
3. prophylactic antibiotics
especially in emergency CS.
a single intra operative dose of cephalosporin+
metronidazole.
Treatment
B. Severe infections :
septic/endotoxic shock
appropriate antibiotics should be aggressively
given ,any delay could be fatal.
Complications
1. Pelvic abscess
salpingo- ophoritis and pelvic peritonitis . This
could progress to a generalized peritonitis and
the development of pelvic absess.
Necrotizing Fasciitis
Diagnosis :
U/S is mandatory.
Treatment :
• IV blood transfusion.
• Syntocinon infusion.
• Antibiotics -should be given if placental tissues are
found even without evidence of overt infection.
evacuation of the uterus under general anesthesia .
Perineal Complications
1.perineal discomfort
• it is the single major problem for mothers in
the first 3 days .
• discomfort is greatest in the presence of
episiotomy ,spontaneous tears following
instrumental delivery.
treatment • local cooling by crushed ice.
• topical anaesthetics as 5% lignocaine gel.
• analgesics -paracetamol or NSAIDs as;
diclofenac suppositories at delivery
followed by another 12h latter.
2. perineal infection
• uncommon , but if signs of infection occur
these must be taken seriously.
• caused by bacterial contamination during delivery
,thus swabs from infected wounds for culture &
antibiotic sensitivity.
treatment
• antibiotics.
• drainage if there is pus, is collected by removal of
any skin sutures.
• .if there is spontaneous opening of repaired tears or
episiotomy ,in presence of infection,
should be irrigated twice daily
(4) Bladder Dysfunction
• Voiding difficulty and over-distention of the
bladder are not uncommon after delivery ,
especially ,if epidural or spinal anesthesia
has been used.
Causes
• after epidural anesthesia the bladder may
take 8 – 12h to regain normal sensation.
• During this time about 1 liter of urine is
produced and therefore ,urinary retention
occurs.
• caused also by pain or peri urethral edema due to
traumatic delivery as :
instrumental delivery , multiple extended
lacerations ,vulvo vaginal hematomas .