PRESENTATION ON: PUEPERAL SEPSIS

SUBMITTED BY : DHANA BC
SUBMITTED TO : SANDHYA KISMITA RAI
MAAM BSC 3RD YEAR
CONTENT
DEFINITION
CAUSES
TYPES
CLINICAL FEATURES
OCCURENCE
DIAGNOSIS
PREVENTION
MANAGEMENT
REFRENCES
What is puerperium?
It is the period of about six weeks after childbirth during which the
mother’s reproductive organs return to their original non- pregnant
condition.

During this period the body tissues, in particular the genital and the
pelvic organs, return to the condition in to the pregnancy state of the
women.

The breast don’t come to the previous state.

What is sepsis?
The presence in tissues of harmful bacteria and their toxins , typically
through infection of a wound.

It is a life threatening condition that arises when the body’s response to
infectionn causes injury to its own tissues and organs.
DEFINITION:

An infection of the genital tract

which occurs as a complication of
delivery is term as puerperal sepsis.
It is mainly cause of puerperal
pyrexia.
There has been marked decline in
puerperal sepsis during the past
few years due to improved obstetric
care and availability of wider range
of antibiotics.
INCIDENCE
It is a leading cause of preventable maternal death . Mostly it is caused by
the having the lower economic status, poor health hygiene , unsterile
delivery and haemorrhage. The prevalence rate of puerperal sepsis is more
in developing countries in comparison to developed countries.

According to WHO, estimated account was 15% of 500000 maternal death

anually.
Continue…
In nepal , on study conducted from Jan 2011 to December 2012 at Department of
Obstetrics and Gynaecology, Patan , 122 cases were found.

The contribution of sepsis to the maternal death was 19.2 % and it was the 3 rd
leading cause of death.

On the study conducted on University of Gondar hoaspital, North West

Ethopia, 2017, 17 .2% cases were found with puerperal sepsis . Data was collected
from 219 women. It was found in the woman having a cesarean section , being
primiparous and multiparous.( international journal of pregnancy and child
birth ; Med Crave, 2017 )
Continue….
In Pakistan, sepsis is among the three leading cause of death in post
hospital and community.

15% of maternal death occurred by it . In , Africa , puerperal sepsis is the

second cause of maternal morbidity and mortality, causing 10% of
maternal death . In the United States puerperal sepsis occur 5.5 % of
vaginal deliveries and 7.4 % of caesarean section deliveries. ( Rayond
Kiponza , Belinda Balandya , Mtebe V. Majigo & Mecky Matee Article no
690(2019)
CAUSES
THE INFECTING ORGANISM
THE SOURCE OF INFECTION
THE PRE DISPOSING FACTOR

1.The infecting organism: The organism responsible for puerperal sepsis are as
following :
. Aerobic : staphylococcus pyogenes ,Escherichia coli, klebsiella, pseudomonas, non
haemolytic streptococcus, staphylococcus aureus .
.anaerobic :anaerobic streptococcus , bacteriodes, clostridium welchii, clostridium
tetani.
2. the source of infection: puerperal sepsis is essentially a wound infection .
Placental site (being a raw surface) , laceration of the genital tract , a caesarean
section wound may be infected in the following way:
a) Endogenous source: This is usually from organism already present on
patient vagina and bowel. The organism is non pathogenic in normal
condition. They may become virulent and pathogenic if there is laceration of
birth canal .

b) Exogenous source: organism from the respiratory tract and septic foci of the
patient attendant. The dust in the air of ward , from blanket ,sheets ,etc are
the main source of infection in this variety. The majority of hospital staff carry
staphylococci and streptococci in the respiratory tract and will readily infect
their patient, if adequate precaution are not taken .
c) Autogenous source : the source of infection in this course is from the patient
usually from her respiratory tract, septic foci may also be a source of infection.
3. The predisposing factor: there are various predisposing factor :
. Antepartum factor
. Intrapartum factor

. Antepartum factor: malnutrition, anemia, sexual intercourse during late

pregnancy , premature rupture of membrane, pre eclampsia.

. Intrapartum factor :
-introduction of sepsis into upper genital tract
 Dehydration and ketoacidosis during labour
 Traumatic operative delivery
 Haemorrhage
 Retained bits of placental tissue and membrane
 Prolonged labour with repeated vaginal examination
TYPES
1.Localized infection
2. Widespread infection
3. Spread to peritoneum, peritonitis
4.Septicemia
CLINICAL FEATURES
1.The localized infection
-there is slight rise of temperature, generalized malaise or headache.
-the local wound become red and swollen.
-tachycardia, pain and tenderness over lower abdomen.
-pus may formed which lead to disruption of wound .

2. Widespread infection :
-patient is usually very ill with fever , tachycardia and lower abdominal pain.
-pain and tenderness of calf muscles.
3. peritonitis:
 Rise temperature
 Rapid pulse
 Tender abdomen and vomiting

4. Septicemia :
 This may be occurred in 48 hrs of delivery
 High fever( 39.5 to 40.5 degree celcius)
 Tachycardia ;greater than 120/ min
 Delirium
 Usually abdomen pain absent
 Joint pain
 Symptoms of pericarditis , endocarditis, and pneumonia may develop
 Patient look very ill and toxic
HOW PUERPERAL SEPSIS OCCUR?
 It may start before the onset of labour .
 In case of pre mature rupture of membrane, antibiotic should be given if the
woman has fever and foul smelling vaginal discharge or as a prophylactic
measures to reduce the risk of infection.
 Following delivery , puerperal sepsis may be localized in the perineum ,
vagina , cervix or uterus.
 Infection of uterus can spread rapidly if due to virulent organism or if the
mother resistant is impaired.
 Thrombophlebitis of uterine vein can transport infected clots to other organs.
 It can be rapidly fatal.
DIAGNOSIS
History taking
Clinical examination :
-study of pulse and temperature
 Systematic examination of breast, throat, lungs, heart, liver, spleen ,and legs.
 Abdominal examination
 Internal examination ;ie lochia
 Limbs
Test and investigations :
-blood test, blood culture
-pelvic ultrasound
-CT scan / MRI
-Chest X-ray
-urine test
PREVENTION
Antenatal prevention
It include improvement of nutritional status of pregnant women and eradication of
any septic focus in the body .

Interanatal prevention
It include :
 Full surgical asepsis adopt during delivery .
 Screening for group B streptococcus in a high risk women. Prophylactic use of
antibiotic is not recommended.
 Prophylactic use of antibiotic at the time of CS, significanlly reduce the incidence of
wound infection , endometritis , urinary tract and other serious infection
CONT……
Postpartum prevention:
 It include:
 Too many visitor are restricted.
 Sterilized sanitary pad are to be used.
 Infected babies and mothers should be in isolated room.
MANAGEMENT
Isolation of patient is preferred specially when hemolytic streptococcus is obtain on culture.
Administration of antibiotic as prescribed.
-ampicillin 2gmIV every 6 hrs.
-gentamycin 5mg / kg body weight IV every 24 hrs.
 Metronidazole 500mg IV every 8 hrs.
tetanus toxoid ; if women was exposed to tetanus and there is uncertainity about her
vaccination history.
Give / provide plenty of fluid.
Rulling out retained placental fragment.
Anemia is corrected by oral iron and if needed by blood transfusion
Pain is relieved by adequate analgesics.
Provide skill midwifery care.
Care of newborn
Surgical management
NURSING MANAGEMENT
ASSEMENT
 History taking
 Physical examination
 Laboratory examination
 Ct/ scan , MRI
 Family history
NURSING DIAGNOSIS
-pain related to the inflammatory process.
 Hyperthermia related to the pain .
 Fluid and electrolyte imbalance related to the vomiting.
 Risk for infection related to the lack of personal hygiene.
 Poor appetite related to the abdominal cramp , tenderness of muscles.
Nursing intervention
To relieve pain
-assess the level of pain .
 Provide a comfortable position for the patient.
 Maintain the calm and quiet environment.
 Helps in the promotion of deep breathing exercise.
 If it is not maintain provide the analgesic , antipyretic drugs for the
patient as prescribed.
To reduce the temperature
 Assess the temperature of the patient .
 Ventilate the room and open the fan.
 Remove the clothes and provide the cold sponge to the patient.
 Encourage the patient to take the plenty of fluids.
 Adminstered the antibiotics to the patient as prescribed.
To maintain the fluid and electrolyte balance.
- Encourage the patient to take plenty of fluid.
- Encourage the patient to take high quality of balanced diet food.
 Provision of IV fluids to the patient if needed.
 Provide the appropriate nutrition to the patient.
To reduce infection
 Provision of appropriate midwifery care to the patient.
 Encourage the patient to the to take part in perineal care.
 Use of aseptic technique while providing care to the patient.
 Heath teaching should be provided to mother to maintain perineal
hygiene.
 Hand washing should be done before each and every procedure.
 Appropriate care should be made provision to patient.
REFRENCES
Konar .H, DC Dutta’s Textbook of Obstretics (2008) ,8TH EDITION (PAGE
NO -501 TO 503)
Tuitui .R ,Manual of Midwifery –III, (2012 A.D) 8TH EDIEION, (PG NO -74
TO 77)
Prasai .D, Textbook of Midwifery Nursing ,Part III(2018) ,1 ST EDITION (PG
-72 TO 75 )
Gautam .S, Subedi.D ;Midwifery Nursing , Part III(2011) ,(PG 72 TO 80 )
https;//medcraveonline.com/IPCB/IPCB- 05-00175.pdf
https;//bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-432
https;//www.gfmer.ch/omphi/maternal-infections/pdf/Maternal-sepsis.pdf