Puerperal pyrexia & sepsis

Puerperal Sepsis

1. Puerperal Pyrexia & Sepsis Ms.Sasikalavathi Arunachalam MSc (N) OBG Principal Haryana College of Nursing, Ellenabad

2. Puerperal Pyrexia A rise of temperature 100.4 degree F or more on 2 separate occasions at 24 hrs apart within first 10 days following delivery.

3. Puerperal sepsis An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis

4. Vaginal flora Doderlein’s bacillus Candida albicans Staphylococcus albus Staphylococcus aureus E.coli Cl.welchi on occasion

5. Factors alter the vaginal flora Damage of the cervico vaginal mucus membrane Open wound of placental site Blood clots present at the placental site

6. Predisposing factors of puerperal sepsis Low host resistance Introduction of microorganisms from outside Increased prevalence of organisms resistant to antibiotics

7. Antenatal factors

8. Mode of infection

9. Pathology Perineum Vagina Cervix Uterus - endometritis

10. Spread of infection Pelvic cellulitis ( parametritis ) Salpingitis Septic pelvic thrombophlebitis Septicaemia Septic shock

11. C/F 1) Local infection Slight rise of temperature Generalized malaise or head ache Red & swollen wound Pus When severe there is high rise of temperature with chills & rigor

12. 2) Uterine infection Mild Rise of temperature and pulse rate Offensive and copious lochial discharge Subinvolution Severe Rise of temperature with chills and rigor Rapid pulse rate Scanty and odourless lochia Subinvolution Associated wound infections

13. 3)Spreading infection Parametritis Constant pelvic pain Tenderness on either sides of hypogastrium If suppuration – rise of temperature with chills and rigor, intense pain Gradual deterioration Leucocytosis Pelvic peritonitis Pyrexia with increased pulse rate Lower abdominal pain and tenderness Collection of pus in pouch of doughlas General peritonitis High fever with rapid pulse Vomiting Generalized abdominal pain Dehydrated Tender & distended abdomen Rebound tenderness

14. Management of bacteraemia & septic shock

15. Thank U