The Puerperium, Puerperium period, Puerperium Pyrexia, and Puerperium Sepsis, Causes & Symptoms, Diagnoses and Management, (by GS India Nursing).

Puerperium Pyrexia:-

A rise of temperature reaching 100.4°f, (38°C) or more (measured or orally) on 2 separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days following delivery is called puerperium Pyrexia. In some countries postabortal fever is also included.

Puerperal Pyrexia is defined as the presence of of a fever,which is greater than Or equal to 38°C, in a woman within six weeks of her having given birth.

Note: Puerperium period– Puerperium period (postpartum period) is considered about 6 weeks of pregnancy after childbirth (delivery).

Causes:-

  • Puerperium sepsis.
  • Urinary track infection, (Cystitis, pyelonephritis).
  • Mastitis.
  • Infection of cesarean section wound.
  • Pulmonary infection atelectasis pneumonia.
  • Septic pelvic thrombophlebitis.
  • Unknown origin.
  • Endomyoparametritis.
  • Surgical incision infection.
  • Breast engorgement.
  • Malaria.
  • Tuberculosis.

Puerperium sepsis:-

An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis. Puerperal Pyrexia is considered to be due to genital tract infection unless provide otherwise.

Puerperal sepsis was defined as infection of the genital tract occurring at any time between the onset of rupture of membranes of labour and the 42 day postpartum in which two or more of the following are present. Fever ( oral temperature 38.5°C /101.3°F, or higher on any occasion), pelvic pain.

Causes:-

  • Some of the most common bacteria causing puerperal sepsis are Streptococci, staphylococci, Escherichia coli, ( E-coli) Clostridium tetani, clostridium welchii, chlamydia and gonococci, bacteria which cause sexually transmitted diseases (STD) more than one type of bacteria may be involved in puerperal sepsis.
  • Malnutrition and anemia.
  • Preterm labour.
  • Prolonged rupture of membrane,18 hrs.

Intrapartum factors:-

  • Repeated vaginal examinations.
  • Truma during delivery.
  • Operative delivery.
  • PPH, post partum hemorrhage.
  • Retained placenta.
  • Placenta pravia.
  • Caesarean delivery.

Mode of infection:-

  • Genital tract.
  • Placental site.
  • Cesarean section.

Indigenous:- Sources of infection may be endogenous where organisms or present in the genital tract before delivery. Anaerobic Streptococcus is the predominant pathogen.

Autogenous:- Infection may be are autogenous where organisms, present elsewhere ( skin throat) in the body and migrate to the genital organs by blood stream or by the patient herself. Streptococcus β- haemolyticus, E-coli staphylococcus are important.

Exogenous:- Where infection is contracted from sources outside the patient (from hospital or attendance). Streptococcus β haemolyticus, staphylococcus and E, coli are important.

The primary sites of infection are:-

  • Perineum.
  • Vagina.
  • Cervix.
  • Uterus.

The infection is either localised to the site or spreads to distant sites. The lacerations on the perineum, vagina, and the cervix are often infected by the organism due to the presence of blood clots or dead space. The wounds become red, swollen and there is associated seropurulent discharge. There may be disruption of the wound if repaired, before control of infection. Diabetes, obesity, low nutritional, status are the other high Risk factors for wound infection.

Spread of infection:-

  • Pelvic thrombophlebitis.
  • Pelvic Cellulitis.
  • Oophritis.
  • Salpingitis.
  • Peritonitis.
  • Septic pelvic thrombophlebitis.
  • Septicaemia and septic shock.

Clinical features:-

Local infection (wound infection):-

  • There is slight rise of temperature, generalised malaise or headache.
  • The local wound becomes red and swollen.
  • Pus may from which leads to disruption of the wound. When severe (acute), there is high rise of temperature with chills and rigor.

Uterine infection:-

Mild:-

  • There is rise in temperature and Pulse rate.
  • Lochia discharge becomes offensive and copious.
  • The uterus is subinvoluted and tender.

Severe:-

  • The onset is acute with high rise of temperature, often with chills and rigor.
  • Pulse rate is Rapid out of proportion to temperature.
  • Lochia may be scanty and odourless.
  • Uterus may be subinvoluted tender and softer. Thare may be associated wound infection ( perineum, vagina or the cervix).

Spreading infection:-

  • Parametritis.
  • Pelvic peritonitis.
  • General peritonitis.
  • Thrombophlebitis.
  • Septicaemia.

Diagnosis:-

  • Present history collection.
  • Physical examination.
  • Abdominal examination.
  • Lochia check up.
  • Perineal wound condition check up.
  • Urine Examination.
  • Blood examination.
  • Blood culture.
  • Pelvic ultrasonography.
  • Pelvic x-ray.

Management and treatment:-

Sepsis treated with intravenous doses of appropriate broad-spectrum antibiotics. Antibiotics ideal antibiotic regime should depend on the culture and sensitivity report. Pending the report Gentamicin (2 mg/kg iv loading dose followed by 1.5 mg/ kg IV every eight hrs). and Ampicillin (1 gIV every 6 hrs) or Clindamycin (900 mg IV every 8 hrs) should be strated. Intravenous administration of Cefotaxime 1g.8 hourly is another alternative. Metronidazole 0.5 g, IV is given at 8 hrs interval to control the anaerobic group. The treatment is continued until the infection is controlled for at least 7-10 days.

Prevention:-

  • Maintaining hygiene and hand washing and following strict infection prevention practices before handling mother’s.
  • Reducing frequent PV examination during labour.
  • Early identification and judicious use of antibiotics in mother’s showing sign of infection.

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Thanking you…………..!!

By GS India Nursing………….!!

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