PUERPERAL SEPSIS presentation for medical students

Puerperium sepsis

1. PUERPERAL SEPSIS
COMPILED BY MRS MULUBE/TUTOR

2. GENERALOBJECTIVE
Attheendofthelecturestudentsshouldbeabletohave
anunderstandingofpuerperalsepsis.

3. SPECIFIC OBJECTIVES
Define puerperal sepsis
Outline the causes and predisposing factors
To state the signs and symptoms
To outline the investigations and diagnosis
To state the management
To outline the prognosis and complications

4. INTRODUCTION
PuerperalSepsiscontributestothematernalmortality
rateby11%globally(Say,etal.,2014).
InZambia15%ofmaternaldeathsarecausedby
puerperalsepsis,regrettablythecauseis
preventable(MOH,2013).
Therefore,thiscallsforvigilanceinproviding
appropriatecaretomothersbyallthehealth
personnel.

5. CAUSESOFMATERNALMORTALITYRATE

6. DEFINITION
Puerperal Sepsis
Infectionofthegenitaltractinthefirstsix
weeksfollowinglabourorabortion.
characterizedbytemperaturereaching38
°Cormorein24hours,atleasttwodaysof
thefirst14dayspost-deliveryduetoentry,
growthandmultiplicationofpathogenic
organisms(Sellers,2010).

7. CAUSES OF PUERPERAL SEPSIS
Microorganisms
Thecausativeorganismsareeitheraerobicor
anaerobic.Thesecouldbeendogenousor
exogenous.
Beta-haemolyticstreptococcus, group A, B and
D
Staphylococcus aureus
Escherichia coli
Haemophilusinfluenza

8. CONT.…………….
oGonococcus
oPneumococcus
oPseudomonas

9. MODEOFSPREAD
Autogenous
oOriginatesfromthepatientherself
oThatisfromthehernose,skin,vulva,throat,
faecesoranysepticfocus
Endogenous
oOccursasaresultoforganismsalready
presentinthevagina
oGainsentrythroughbruisedandlaceratedbirth
canal

10. CONT.…………..
Exogenous
oOccursasaresultofcontaminationfrom
attendants’noses,throats,nails&clothes
oAlsofromtheenvironmentthatinadequately
cleanedanddirtylinen

11. PREDISPOSING FACTORS
ANTENATAL FACTORS
Antenatal intrauterine infections
Premature rapture of membranes (PROM)
Antepartum hemorrhage (placenta praevia)
Chronic infections-anemia, diabetes mellitus

12. CONT……………
INTRA-PARTUMFACTORS
oBruises and lacerations
Caesarian section
Internal podalic version
Multiple vaginal examinations

13. CONT……………
Instrumental deliveries
Prolonged labour
Unsterilized instruments
Manual removal of the placenta
Retained products of conception

14. CONT……………..
POSTNATAL FACTORS
•Unhygienic practices
•Poor wound care/episiotomies

15. SIGNS AND SYMPTOMS
Fever 38 degrees Celsius
Tachycardia
Pelvic thrombophlebitis
Uterus –sub-involuted, boggy, tender and
larger

16. CONT…………….
Infected wounds –caesarian/ perineal
Local pain and swelling of the infected
suture line.
Malaise, headache, chills, rigors and
insomnia

17. CONT……………..
Foul smelling lochia (brownish in colour)
Secondary post-partum haemorrhage
Severe infection of the fallopian tubes

18. CONT……………..
Collection of pus in the pouch of Douglas
Anorexia
Diarrhea

19. DIAGNOSIS
Detailed history taking on;
General condition during pregnancy
Summary of labour
Place of delivery
Type of labour and delivery whether
prolonged or instrumental

20. CONT……………..
oOnset of fever
oVital signs
oPhysical examination from head to toe

21. INVESTIGATIONS
Pelvic ultra-sonogram
Mid-stream specimen of urine
High vaginal swab
Endocervical swab

22. CONTI………………
Throat swab from patient to isolate the
causative microorganism
Nose swab from patient
Full blood count
Blood culture and sensitivity
Bleeding and clotting time

23. CONT……………………….
Blood slide

24. MEDICAL MANAGEMENT
Puerperalsepsisneedsprompttreatmentwith
tripleantibioticstocombatallthepossible
causativeorganisms.Theseinclude;
Amoxyl;500mgthreetimesdailyforfive-
sevendays.
Gentamycin,80mgthreetimesdailyforfive-
sevendays(IM)

25. CONT………….
Ampicillin, 500 mg, 6 hourly, I.V/ Oral for
five-seven days.
oMetronidazole, 400mg, Oral,(I.V 400mg)
three times daily or 8 hourly, for 5-7days
Analgesics
Pethidine 50-100mg 8 hourly maximum of
three doses.

26. CONT………….
oDiclofenac, 75-100mg, three times daily, for
3 days, orally
oParacetamol, 1 g, 3 times daily, orally for 3
days
oBrufen, 400 mg, 3 times daily, orally for
3days

27. CONT………..
Surgical treatment
oPerinealwound-remove stitches
oPelvic abscess-Laparatomy
oRetained products of conception-MVA
Intravenous fluids
oRequired in severe cases for flushing out
toxins and for drug administration.

28. CONT………….
Blood transfusion
If the patient has severe anemia

29. MIDWIFERYCARE
Psychological care
Isolation
Rest
Observations
Hygiene

30. CONT…………
Exercise
Nutrition
Elimination

31. PROGNOSIS
Antibiotictherapyandothertreatment
measuresarevirtuallyalwayssuccessfulin
curingpuerperalinfections.
Improved with early detection
andappropriatemedicalandnursing
management

32. PREVENTION OF PEUPERAL SEPSIS
ANTENATALLY
Educatethepatientontheimportanceof
hygiene,adequaterestandsleep
Earlyantenatalbookingforearlydetection
andtreatmentofinfectionanddiseases
Good nutrition
Importance of hospital delivery

33. INTRAPARTUM
Isolate patient with infections
Aseptic technique in all procedures
Minimize vaginal examinations
Reduce traffic in labour ward
Antibiotic cover in PROM
Use of partograph

34. CONT.………..
Avoidunnecessaryepisiotomies
Medicalstaffattendingtopatientsshouldbe
freefromupperrespiratoryinfections
Inspectplacentacarefullytomakesurethere
arenoretainedproductsofconception
Ensurethatdumpdustingisdoneeverydayto
preventdustaccumulation

35. CONT.……….
Traintraditionalbirthattendants(TBAS)on
howtoconductcleanandsafedeliveries
Encouragefrequentopeningofthebladder
toavoidretainedurine

36. POSTPARTUM
Isolate infected patients
Promote personal hygiene
Aseptic techniques in procedures like vulva
toilet
Control of staff infections such as
respiratory tract infections

37. CONT.……..
Record vital signs accurately
Prompt treatment of complications such as
perinealtear

38. COMPLICATIONS
Peritonitis-Duetospreadofinfectiontothe
peritoneum
Septicemia-Untreatedinfectioninvadesthe
vascularsystem
Infertility-Followingsalpingitiswherethere
maybeblockageoffallopiantubesleading
tohealingbyscaring

39. CONT.………….
Anaemia-Due to haemolysis of the red
blood cells
Cervicitis-Inflammation of the cervix
Salpingitis, -Inflammation of the fallopian
tubes
Thrombophlebitis-Inflammation of the veins

40. CONT.………….
Endometritis-Inflammation of the
endometrial
Pelvicabscess-duetoahighlylocalized
infection
Disseminatedintravascularcoagulopathy
duetotoxinsfromthebacteria.

41. REFERENCES
Ngoma, C.M. (2003). Reproductive health with a focus on
safe motherhood. Lusaka: Zambia Educational
Publishing House.
Pauline M. S. (2010).Midwifery, Volume 2, 12
th
edition,
Jutaand Co. Ltd.
Say L. et al. (2014). Global Causes of Maternal Death:
A WHO Systematic Analysis.Lancet.