PUERPERAL

INFECTION
 Puerperalfever
 Postpartum fever
 Puerperal sepsis
 Childbed fever
DEFINITION :

Bacterial infection following

childbirth
•Infection of the birth canal after the
first 24
hours following delivery of a baby
•Temperature > 38o C (taken by
mouth, 4
times daily)
•Occur on any two of the first 10 days
Predisposing factors
1. Antepartum factors
 Anemia
 Nutrition
 Sexual intercourse
 PROM

2. INTRAPARTUM FACTORS
 Iatrogenic introduction of pathogen
bacteria (into the birth canal)
 Trauma (devitalizes tissue)
 Hemorrhage
PATHOLOGY

 Decrease of protective mechanism

 Plasental site = portal of entry
 The lochia = excellent culture
media
 Ascending infection
Episiotomy infection
Perineal lacerations infection
Lesions of vulva/vagina and
cervix
do not occur more often
(due to excellent local blood supply)
large episiotomy  greater risk
Vaginitis/Servicitis infection
during pregnancy
Bad hygiene
Episiotomy infection…………

Clinical findings :
 Pain at episiotomy site
 Dysuria with or without urinary
retention
 Disruption of the wound
 Gaping incision
 Necrotic debris / pus
 Body temp. < 38.5 oC
Episiotomy infection…………

Treatment :`
 Cleaning the wound
 Promoting formation
granulation
tissue
 Debridement (Warm Sitz baths)
 Perineoraphy
 ENDOMETRITIS

Etiology :
 PROM
 Chorioamnionitis
 Excessive number of vaginal
examinations
 Prolonged labor
 Vaginitis/Cervicitis
ENDOMETRITIS…….

 Intrauterine pressure
catheter
 Low sosioeconomic status
 Operative vaginal
deliveries
 Poor nutrition
 Coitus near term
Endometritis……………
Clinical findings :
Symptoms and Signs :
 Fever (between 38 oC s/d 40
o
C)
 Soft & tender uterus
 Lochia foul odor
Endometritis………..
LABORATORY FINDINGS :
* Leukocytosis
* Urinalysis (pyuria/Bacterial
cultures) * Lochia cultures
* Sensitivity antimicrobial test
Endometritis……….

Treatment :
 Antibiotics ( Aerob & Anaerob
m.o)
(Ampicillin + Aminoglycosides)
(Cephalosporine 2nd/3rd
generation)
(Clyndamycin)
 Uterotonic
 Fowler position
 Extension of Puerperal
Infection
1. Extension via superficial
epithelization
(Percontinuitatum)
 Endometritis
 Salpingitis
 Pelveoperitonitis
 Peritonitis
Extension of Puerperal infection…….

2. Extension via veins

 Phlebitis  Sepsis
 Periphlebitis
 Parametritis
 Extension via uterine
3.
wall
 Endometritis
 Myometritis
 Perimetritis
 Parametritis
4. Extension via
Lymphatic
 Limphangitis
 Perilimphangitis
 Parametritis
Extension of puerperal infection in
peritonitis
Salpingitis :

 Most often with

postpartum
sepsis
 Gonorrheal salpingitis
(rare) 
infertility
Pelvic Cellulitis (Parametritis)

 Common cause of prolonged sustain

fever
 Tenderness of the lower abdomen
(one or both sides)
 Tenderness of vaginal examination
 Fixation uterus by parametrial
exudate
 Mass in broad ligament
Extension of puerperal infection in
pelvic (parametritis)
Septic Thrombophlebitis :
 Repeated chills
 Swings in the temperature
 Hypotension
 Lasted for many weeks
 Severe complication :
 pneumonitis
 infarction
 abscesses
 septic embolism
Extension of puerperal infection in
peritonitis
Extension of puerperal infection in pelvic
thrombophlebitis.
Peritonitis

 Severe abdominal
pain
 Abdominal rigidity
 Marked bowel
distension
 Paralytic ileus
Treatment :
Choice of antibiotics
(penicillin + gentamycin)
(penicillin + aminoglycosides)
(clindamycin + gentamycin)
(penicillin + tetracycline)
 Analgetic
 Fluid & Electrolyt
 Operative
PREVENTIVE CARE

1.During Pregnancy
 anemia
 nutrition
 genital infection
 coitus near term
 PREVENTIVE CARE…...

2. During parturition
 Safe and Clean delivery
 avoid infection (hygiene/antiseptic
procedure)
 avoid large episiotomy
 avoid bleeding
 avoid prolonged labor

3. During puerperium
 Hygiene