Puerperal Sepsis

Post partum complications:
Puerperal sepsis
Thromboembolic disorders
Postpartum blues
MS.ANTO UDHAYA PANDY
BNUR 414
Objectives
At the end of the lecture the student should be able to:
• Define puerperal sepsis
• Identify the risk factors for developing puerperal sepsis
• Discuss the signs and symptoms of puerperal sepsis
• Describe management and nursing care
• Describe subinvolution of the uterus in term of definition,
causes, signs and management
• Describe thrombo embolic disorders
• Describe postpartum blues
Puerperal sepsis
Definition
The definition of puerperal infection is a temperature
of 38 0 C of higher after the first 24 hours and this
occurring on at least 2 of the 10 days following
childbirth
• Also known as postpartum infection.
Common post partum infections
Endometritis – infectious condition involves
endometrium, caused by organisms which are
normal inhabitants of vagina and cervix.
Wound infections – Cesarean incisions,
episiotomy site, perineal and genital tract
lacerations
Urinary tract infections
Mastitis – occurs with in first 2 weeks post
partum. Inflammation of breast
Risk factors
History of previous infection (UTI, mastitis,
thrombophlebitis) – more vulnerable to infectious
process
Colonization of lower genital tract by pathogenic
organisms – Infections caused by several microbes
that have ascended to uterus from lower genital tract
Cesarean birth – Provides portal of entry for bacteria
Trauma – entrance for bacteria and makes tissue more
susceptible
Prolonged rupture of membranes – Removes barrier
of amniotic membranes, allows access of organisms to
uterus
Prolonged labor – multiple vaginal examinations –
allows time for bacteria to multiply
Risk factors
Retained placental fragments – Provide
growth medium for bacteria and may interfere
with flow of lochia
Hemorrhage – Results in loss of infection
fighting components of blood
Poor general health ( excessive fatigue,
anemia, frequent minor illnesses)
Poor nutrition
Poor hygiene
Medical conditions such as diabetes mellitus
Low socio economic status
Signs and symptoms
Fever, chills
Pain or redness of wounds
Purulent wound discharge or wound edges not approximated
Uterine sub involution
Tachycardia
Abnormal duration of lochia and foul odor
Elevated WBC count
Frequent urgent urination, dysuria, hematuria
Suprapubic pain
Localized area of warmth, redness or tenderness in the
breasts
Body aches and general malaise
Uterine tenderness in endometritis
Therapeutic Management
IV antibiotics for endometritis.
Single prophylactic dose of IV antibiotic to any women
with cesarean birth. Which given during surgery after
umbilical cord clamping to avoid exposure of the infant
to drug.
Antipyretics for fever and oxytocin to increase lochia
and promote involution.
In wound infection – Incision and drainage of the
affected area if necessary.
Broad spectrum antibiotics and Analgesics.
Surgical debridement for necrotizing fasciitis.
UTI can be treated with oral or IV antibiotics and urinary
analgesics.
Antibiotics that are safe for use during lactation are
given if the mother is breastfeeding.
In mastitis antibiotic therapy and continued emptying of
the breast is the first line of treatment.
Women with breast abscess are treated with surgical
drainage and antibiotics.
Supportive measures include application of moist heat
or ice packs, breast support, bed rest and analgesics.
Continue breast feed from both the breast.
Nursing management
Assess vital signs q4h
Observe surgical incisions for redness, tenderness,
edema, drainage, and approximation : REEDA
Observe lochia for amount and odor every 4 hours
Encourage patient to empty bladder frequently and to
report any symptoms of UTI
Instruct patient regarding good hygienic practices
Wipe from front to back
Perineal cleansing after elimination
Changing sanitary pad frequently
Careful hand washing before and after perineal care
Nursing management
Initiate measures to reduce UTI
Increased fluid intake 2-3 ltrs per day
Monitor bladder distention to prevent over filling,
encourage patient to void frequently
Use methods to promote bladder emptying
Teach and assist patient with proper breast feeding
Teach patient regarding proper nutrition – well balanced
meal
Organizing periods of rest for mother
Teach patient signs of infection which she should report
to he health care provider
Mastitis
• Infection of the breast that
develops 2-4 weeks after birth
• 5-10% women affected.
• Affects just one breast
• Caused by Staphylococcus
aureus, Staph albus, E. coli or
streptococci
• Bacteria on skin of mother or in
nose mouth of newborn
• Enters breast through cracked
nipple
• Engorgement and stasis of milk
precede mastitis
• Constriction of bra interfere with
emptying of breast
Clinical signs and symptoms
• Flu symptoms
• Chills fever, malaise
• Headache
• Characterized by local lump or wedge shaped area of
pain, redness, enlarged axillary lymph nodes
• Hard and tender area
• Untreated – breast abscess
• Therapeutic management
• Antibiotics
• Continuous emptying of breasts condition usually
resolves 24-28 hours
• Supportive – moist heat packs, ice packs analgesics
and bed rest
Nursing intervention
Management focusses on two aspects:

1. Emptying breast and
2. Controlling infection
Education on prevention
• Correct positioning of infant during feeding
• Avoid nipple trauma
• Empty breasts
• Continue breastfeeding during mastitis
Subinvolution of the uterus.
Definition
Slower than expected return of the uterus to nonpregnant size
Normal decent of uterus is 1 cm per day – by day 14 uterus no
longer palpable above symphysis pubis
Most common causes of subinvolution

• Retained placental fragments
• Pelvic infection
Signs:
Prolong discharge of lochia
Irregular or excessive bleeding
Pelvic pain or heaviness
Backache
Fatigue and malaise
Management of sub involution:
Methergine orally
Antimicrobial therapy
Nursing management:
Educate the mother and family
Demonstrate locating and palpating the fundus
Explain about the diseases condition
Thromboembolic disorders
Three most common disorders
• Superficial venous
thrombophlebitis (SVT) :
saphenous venous system –
lower leg
• Deep vein thrombosis (DVT) :
veins from foot to iliofemoral
region – major concern –
predisposes PE
• Pulmonary embolism
(occasionally) – potentially fatal
– obstruction of pulmonary
artery by clot swept from vein to
circulation or by amniotic fluid
Thromboembolic disorder
Incidence 1:1000-2000
Occurrence – twice likely in pregnancy and
5.5 likely in puerperium
Leading cause of maternal death in US
Thrombus = collection of blood factors –
platelets and fibrin
Thromboembolic disorder
Three major causes
 Venous stasis – compression of large vessels of
pelvis and legs by growing uterus
 Hypercoagulable blood – changes in fibrinolytic
system during pregnancy. Factors that promote
clot formation is increased to promote clot
formation to prevent maternal hemorrhages
 Injury to endothelial surface – during cesarean
birth , 9 x higher risk,
Homan’s sign
DVT – Therapeutic management
Prevention of thrombus formation
Enoxaparin
Bed rest
Laboratory testing – PTT response to medication
Analgesics
Antibiotics
Monitor signs of bleeding
Prevention patient education
Nursing consideration:
Monitor for signs
Facilitating oxygenation
Seeking assistance
Explaining continued therapy
Helping the family adapt to home care
Septic pelvic thrombophlebitis is considered the least common
type of puerperal infections.
Postpartum mood disorders
Postpartum women have an increased risk for
• Mood disorders such as post partum blues, depression and
psychosis.
• Anxiety disorders such as obsessive compulsive disorders,
general anxiety disorders and panic disorders.
Bipolar disorders are rare
Postpartum mood disorders are disturbances in the function,
affect and thought processes of women which can seriously
affect the after birth.
Postpartum blues (baby blues) is a transient self limiting
mood disorder but
Postpartum depression, , postpartum psychosis and
postpartum bipolar disorders are much more serious which
disrupt family life and needs intervention.
Postpartum depression
• A period of depression – onset during pregnancy or within
four weeks postpartum and last for at least two weeks.
• Most common complication of childbirth , affects all ethnic
groups and are underdiagnosed and underreported.
• Occurs most likely in primigravidas
• Risk factors for post partum depression – see textbook
p293(BOX 11-4)
• Signs and symptoms p 293
• Therapeutic management - discussion
Other disorders
• Post partum psychosis – Psychosis is a mental state where a
person’s ability to recognize reality and to communicate and
relate to others are impaired.
• Post partum psychosis can be classified as a depressed and
manic type of psychosis – rare condition. Psychiatric
emergency
• Bipolar 11 disorder – women suffer from periods of irritability,
hyperactivity and euphoria. Make infant care impossible.
• Postpartum anxiety disorders – include post partum OCD, post
traumatic stress, panic disorders.
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Post partum complications:

Management focusses on two aspects:

Most common causes of subinvolution

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