What is a puerperal infection?

A puerperal infection occurs when bacteria infect the uterus and surrounding areas after a

woman gives birth. It’s also known as a postpartum infection.

There are several types of postpartum infections, including:

✓endometritis: an infection of the uterine lining

✓myometritis: an infection of the uterine muscle

✓parametritis: an infection of the areas around the uterus

Etiology

Puerperal infections can be caused by poor sterile technique, delivery with significant

manipulation, cesarean birth, or overgrowth of local flora.

Pathophysiology

1. Causative organisms

a.Aerobic organisms include beta-hemolytic streptococci, Escherichia coli, Klebsiella, Proteus

mirabilis, Pseudomonas, Staphylococcus aureus, and Neisseria.

 b.Anaerobic organisms include Bacteroides, Peptostreptococcus, Peptococcus, and

Clostridium perfringens.

2. In parametritis (pelvic cellulitis), infection spreads by way of the lymphatics of the connective

tissue surrounding the uterus.

3. Puerperal infection may extend to the peritoneum by way of the lymph nodes and uterine

wall.

Predisposing factors

1. Lower socioeconmic status

2. Anemia and poor nutrition

3. Previous bacteria colonization

Assessment Findings

1. Clinical manifestations

• Puerperal morbidity is marked by a temperature of 38°C (100.4°F) or higher after the first 24

hours postpartum on any two of the first 10 postpartum days.

• Localized vaginal, vulval, and perineal infections are marked by pain, elevated temperature,

edema, redness, firmness, and tenderness at the sit of the wound; sensations of heat; burning

on urination; and discharge from the wound.

• Manifestations of endometritis include a rise in temperature for several days. In severe

endometritis, symptoms include malaise, headache, backache, general discomfort, loss of

appetite, large tender uterus, severe postpartum cramping, and brownish red, foul-smelling

lochia.

•Parametritis (pelvic cellulitis) commonly produces elevated temperature of more than 38.6°C

(102° to 104°F), chills, abdominal pain, subinvolution of uterus, tachycardia, and lethargy.

Signs and symptoms of peritonitis include high fever, rapid pulse, abdominal pains, nausea,

vomiting, and restlessness.

Complications

Complications are rare. But they can develop if the infection isn’t diagnosed and treated

quickly. Possible complications include:

1. abscesses, or pockets of pus

2. peritonitis, or an inflammation of the abdominal lining

3. pelvic thrombophlebitis, or blood clots in the pelvic veins

4. pulmonary embolism, a condition in which a blood clot blocks an artery in the lungs.
5. sepsis or septic shock, a condition in which bacteria get into the bloodstream and cause

dangerous inflammation

Laboratory and diagnostic studies

Laboratory studies should include the following:

1.Complete blood count

2.Electrolytes

3.Blood cultures, if sepsis is suspected

4.Urinalysis, with cultures and sensitivity tests

5.Cervical or uterine cultures

6.Wound cultures, if appropriate

Medical management

1. Aseptic technique, avoid cross infection

2. Antibiotic therapy

3. Supportive therapy is used to control pain and maintain hydration and nutritional status

4. Drainage is indicated for abcess development

Nursing diagnosis
1. Risk for infection

2. Acute pain

3. Risk for Altered Parent- Infant Attachment

4. Imbalanced Nutrition: less than body requirement

Pharmacologic treatment

1. Gentamicin (1.5 mg/kg/8 hrs) + clindamycin (900mg/8hrs)

2. Metronidazole (500 mg/8 hrs) + penicilin(5 million units/6 hr)

3. Clindamycin + aztreonam (2mg/8hrs)

4. Ampicilin (2mg/6 hrs) + gentamycin

Nursing Management

1. Promote resolution of the infectious process.

• Inspect the perineum twice daily for redness, edema, ecchymosis, and discharge.

• Evaluate for abdominal pain, fever, malaise, tachycardia, and foul-smelling lochia.

• Obtain specimens for laboratory analysis; report the findings.

• Offer a balanced diet, frequent fluids, and early ambulation.

• Administer prescribed antibiotics or medications; document the client’s response.

2. Provide client and family teaching. Describe and demonstrate self-care, stressing careful

perineal hygiene and handwashing.