PUERPERAL SEPSIS & UTI.ppt

Puerperal Sepsis, UTI management

1. PUERPERAL SEPSIS AND
URINARY TRACT INFECTION
BY:
MS. LAMNUNNEM HAOKIP
SENIOR TUTOR/LECTURER
OBG NURSING
SSNSR, SU

2. PUERPERIUM
Puerperiumistheperiodfollowingchildbirthduring
whichthebodytissues,speciallythepelvicorgansrevert
backapproximatelytothepre-pregnantstateboth
anatomicallyandphysiologicallywithin6wks.
Thekeytomanagementofsepsisisearlyrecognition,
aggressiveresuscitation,antibioticadministrationand
sourcecontrol.

3. INCIDENCES
Worldwide, more than 500 000 women die of
complications of pregnancy and childbirth

4. PUERPERAL SEPSIS
Definition : An infection of the genital tract which occurs
as a complication of delivery is termed puerperal sepsis.

5. COMMON PUERPERAL INFECTIONS
Endometritis
Endomyometritis
Endoparametritis
Combination of theses three is called
pelvic cellulitis.

6. CAUSATIVE ORGANISM
Doderleinbacillus(60-70%)
Yeastlikefungus–candidaalbicans(25%)
Staphylococcusalbusoraureus
Streptococcus–anerobiccommon
Betahemolyticusstreptococcusrare
E.coli

7. PREDISPOSING FACTORS
Antepartum factors :
•Malnutrition and anaemia
•Preterm labor
•Premature rupture of the membrane
•Chronic deliberating illness
•Prolonged rupture of the membrane

8. •Repeated vaginal examination
•Prolonged rupture of the membranes
•Dehydration and keto-acidosis during labor
•Traumatic operative delivery
•Haemorrhage -antepartum or postpartum
•Retained bits of the placental tissue or membranes
•Placental praevia –placental site lying close to the vagina
•Caesarean delivery
Intrapartum factors

9. PATHOGENESIS
•Transmitted by another person
•Source -midwife, doctor and other
patients or visitors
EXOGENOUS
•Causative organisms -Streptococcus
fecalis
•Anaerobic streptococci and
clostridium welchifound in the
vagina
ENDOGENOUS

10. SIGN AND SYMPTOMS
Local infection-
Slight raise in temperature, generalized malaise and
headache.
Redness and the swelling of the local wound
Pus formation and disruption of wound
Uterine infection-mild infection
Pyrexia of variable degree and tachycardia.
Red, copious, offensive lochia & tender and soft
uterus.

11. CONT…
Fever which occurs within 24 hours or more is the
first sign.
Increased Pulse rate .
The uterus is sub-involuted,.
Foul smelling vaginal discharge.
Local pain and swelling of the infected suture line.
Headache, insomnia and anorexia

12. In severe sepsis:
Constant pelvic pain.
Rise in temperature with increased pulse rate.
Lower abdominal pain.
Intense pain which worsens the condition of the
patients.
Severe infection of the fallopian tubules.
Collection of pus in the pouch of Douglas.

13. ⚫Bacteriological study-
Smear
Culture and antibiotic sensitivity of
purulent material
High vaginal and cervical swabs
Peritoneal fluids
Blood culture
INVESTIGATIONS

14. Urine :-
Routine and microscopic examination
Culture if infection is suspected
CBC Profile

15. Ultrasonography-
For diagnosis of pelvic masses
Pelvic abscess
Pelvic peritonitis
Retained bits of placenta and/ or membrane
Other:
X-Ray

16. PROPHYLAXIS
ANTENATAL
INTRANATAL
POSTNATAL

17. ANTENATAL
Improvementofgeneralcondition
Treatmentofsepticcocci
Abstinencefromsexualintercourseinthelasttwo
months
Careaboutpersonalhygiene–bathingindirtywaterto
beavoided
Avoidingcontactwithpeoplehavinginfection,suchas
cold,boils.
Avoidingunnecessaryvaginalexaminationsanddouches
inthelatermonths.

18. INTRAPARTUM
Staff attending on labor client should be free of
infections.
Full surgical asepsis to be taken while conducting
delivery
Prophylactic antibiotic must be administered in cases
of caesarean section to reduced the incidence of
wound infection, endometritis UTI.
Ceftriaxone 1g IV immediately after cord clamping
and a second dose after 8 hours is recommended.

19. POSTPARTUM
Takeasepticprecautionswhiledressingtheperineal
wound
Restrictionofthevisitorinthepostpartumward
Motherstobeinstructedtousesterilesanitarypads
andtochangethemfrequently
Vulvaandperineumtobecleanedwithmild
antisepticsolutionfollowingurinationanddefecation
Infectedmothersandbabiesaretobeisolated

20. TREATMENT
1.ISOLATION OF PATIENT: specially when
haemolytic streptococcus is obtained on culture.
2.MAINTAIN INTAKE & OUTPUT
3.INDWELLING CATHETER: to relieve any urine
retention due to pelvic abscess.
4.ANTIBIOTIC: intravenous administration of
cefotaxim 1g, 8hrly & metronidazole 0.5g, every 8
hrly. The treatment is continued for at least 7-10
days.

21. SURGICAL INTERVENTION
PERINEAL WOUND:
•Thestitchesoftheperinealwoundmayhavetobe
removedtofacilitatedrainageofpusandrelievepain
Aftertheinfectioniscontrolled,secondarysutures
maybegivenlater.
RETAINEDUTERINEPRODUCTS
PELVICABSCESS :shouldbedrainedby
colpotomyunderultrasoundguidance.
HYSTRECTOMY

22. URINARY TRACT
INFECTION

23. DEFINITION
It is an infection of the urinary organs
such as kidney, ureter, urinary bladder
and urethra.
The causative organisms are:
⚫E. coli
⚫Klebsiella
⚫Proteus
⚫Staphylococcus aureus

24. Others:
⚫Recurrence of previous cystitis and pyelitis
⚫Infection contracted for the first time during
pregnancy is due to :-
Effect of frequent catheterization either during labor
or in early puerperium to relative retention of urine.
Stasis of urine during early puerperium due to lack of
bladder tone and less desire to pass urine.

25. CLINICAL FEATURES
Raised temperature ( pyrexia)
Costovertebral angle pain
Supra pubic discomfort
Frequent and often painful micturition
Nausea and vomiting

26. DIAGNOSIS
UTIisconfirmedbyexaminationofan
uncontaminatedmidstreamcleancatch
sampleforurinalysisandcultureand
antibioticsensitivitytest.

27. MANAGEMENT
Adequate intake of fluids
Adequate drainage of urine
Keeping the perineal area clean and hygienic
Frequent changing of inner wears
Used of clean warm water
Proper Antimicrobial therapy: Ceftriaxone 250 mg 6 hours apart or
500 mg 8 hours apart IV.

28. BIBLIOGRAPHY/REFERENCES
•AnnammaJabob.AcomprehensivetextbookofMidwiferyandGynaecological
Nursing,Fourthedition.
•LilyPodder.FundamentalsofMidwiferyandObstetricalNursing.ELSEVIER.
•DCDutta’stextbookofObstetrics.HiralalKonar8
th
Edition.JaypeeTheHealth
SciencesPublisher.
•https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/puerperal-sepsis
•https://pubmed.ncbi.nlm.nih.gov/23993724/