Infections after delivery

Postpartum Infections (puerperal

Infection)
Any infection of the reproductive tract,
associated with giving birth, usually
occurring within 10 days of birth.
Another leading cause of maternal
mortality
The uterus is sterile during pregnancy and
until the membrane rupture where
pathogens can invade.
Predisposing factors
Prolonged rupture of membrane.
Caesarian birth
Trauma during birth process
Preexisting maternal anemia
Retained placenta fragments
Local vaginal infection
Abnormal bleeding
Infection is localized or systemic
Assessment
Temperature of 100.4 degree F (37.8
degree C) or more for 2 consecutive days
excluding the first 24 hours.
Abdominal perineal or pelvic pain
Foul smelling vaginal discharge
Burning sensation with urination
Chill, malaise
Rapid pulse, respiration
 elevated WBC count, positive culture &
sensitivity report for causative organism.
Nursing Interventions
Force fluids; client may need more than 3
liters/day
Administer antibiotic and other
medications as ordered.
Treat symptoms as they arise e.g. warmz
sitz bath for infection in episiotomy
Encourage high calorie, high protein diet
to promote tissue healing
Position client in semi to high fowler’s to
promote drainage and reflux higher into
reproductive tract.
Support baby if isolated from mother.
Urinary Tract Infection
May be caused postpartally by coliform
bacteria, coupled with bladder trauma
during delivery, or a break in technique
during catherization.
Assessment
Pain in the suprapubic area or at the
costovertebral angle.
Fever and chills
Burning, urgency, frequency in urination
 increased WBC count
Hematuria
Interventions
Check status of the bladder frequently in
postpartum client
Use nursing measures to encourage client
to void.
Force fluids; may need minimum of 3
liters/day
Catheterize client if ordered, using sterile
technique
Administer medications as ordered
Monitor status of progress through
continuing laboratory test
 support mother with explanations of
interventions
No need of baby to be separated from
mother.
Mastitis
Infection of the breast, usually unilateral
Frequently caused by cracked nipples in
nursing mother
 causative organism usually hemolytic S.
aureus.
Assessment
Temperature and pulse elevated
Elevated vital signs
Redness, tenderness or hardened areas in
breast
Maternal chills and malaise
Nursing Interventions
Teach stress importance of handwashing
to nursing mother and wash own hands
before touching client’s breast.
Administer antibiotic as ordered
Apply ice if ordered between findings
Empty breast regular; baby may continue
to nurse or have mother use hospital grade
pump.
Wound Infection
Wound infections are common types of
peurperal because any break in the skin or
mucus membrane provides a portal for
bacteria.
 the most common sites are caesarian
surgical incisions; the perinuem, where
episiotomies and lacerations are common.
Assessment
Tenderness
Redness
 edema
Edges of the wound may pull apart
Warmth
Infection 9generalized with fever & malaise
Pain
Seropurulent drainage
Nursing Interventions
Apply ice if ordered between findings
 wound infection may require admittance
to the hospital or home health care visits.
The woman requires reassurance and
supportive care.
If at home, she needs teaching about sitz
bath, warm compress, and frequent
perineal care.
She is taught to wipe from front to back and
to change perineal pads frequently.
 good hand washing techniques are
emphasized.
Adequate fluid intake and diet are important
 infant is not routinely isolated from the
mother with a wound infection, but she
must be advised to protect her infant from
contact with contaminate such as dressings.
An incision and drainage of the affected
area may be necessary.
Broad – spectrum antibiotics are ordered
until a report of organism is returned
Analgesics are necessary, and warm
compress or sitz bath may be used to
provide comfort and to promote healing
by increasing circulation to the area.
An incision of drainage of the affected
area may be necessary
Broad term spectrum antibiotics are
ordered until a report of organism is
returned.
Analgesics are necessary, and warm
compress or sitz bath may be used to
provide comfort and to promote healing
by increasing circulation to the areas.
Endometritis
An incision and drainage of the affected
area may be necessary
Infection of the endometrium affecting
the lining of the uterus.
Bacteria may gain access to the uterus
through the vagina at the time of birth or
postpartal period.
Maybe associated with chorioamnionitis
and caesarian birth.
Assessment
Blood in the urine (hematuria)
Increased WBC (30,000 cells/mm3
Malaise
Chills; constipation or diarrhea
Lochia – dark brown, foul odor
Elevation of temperature is benign on the
postpartal period
Fever on the 3rd or 4th postpartal day,
suggesting invasion of micro organism
occurred during labor and birth
Loss of appetite
Lower abdominal pain; low back pain
Irregular or heavy menstrual bleeding
Poor uterine involution or uterus not well
contracted.
Interventions
Administration of appropriate antibiotic,
such as clindamycin (Cleocin).
Be sure to obtain the culture from the
vagina using sterile swab rather than from
the perineal pad to ensure that the infectious
organism is not related to the pad.
An oxytocic agent such as methergine may
be prescribed to encourage uterine
contraction.
The woman requires additional fluid to
combat the fever.
 if strong, after pains and Abdominal
discomfort are present, she needs an
analgesics for pain relief.
Sitting in a fowler position or walking
encourages lochia drainage by gravity and
helps prevent pooling of infected
secretions.
Teach the woman to use good hand
washing techniques before and after
handling perineal pads.
Client teaching about the signs and
symptoms of endometritis is essential.
At a future time if woman desires more
children, she may need fertility assessment
including hysterosalphingogram to
determine tubal patency.
Infection of the Perinuem
Ifa woman has suture line on her
perineum from episotomy or laceration
repair, portal of entry exist for bacterial
invasion.
Assessment
Pain, heat and feeling pressure
Infection of the perineum usually remains
localized
 inflammation of suture line
 may or may not have an elevated temperature,
depending on the systemic effect and spread of
infection.
Stitches on or two may be sloughed away, or
an area of the suture line may be open with
purulent drainage present.
Nursing Intervention
A woman’s physician or a nurse may
remove the perineal sutures, to open the
area and allow for drainage.
Packing such as iodoform gauze, may be
placed in the open lesion to keep it open
and allow drainage.
A systemic or topical antibiotic is ordered
even before the culture report is returned.
An analgesic maybe prescribed to alleviate
discomfort.
Sitz bath or warm compresses may be ordered
to hasten drainage and cleanse the area.
Remind the woman to change the pads
frequently.
There is no need to restrict the woman to from
caring for her infant, as well as she washes her
hands before holding her newborn.
Encourage mother to ambulate.
Peritonitis
Infection of the peritoneal cavity, usually
an extension of endomitritis.
It is one of gravest complications of
childbearing and a major cause of death
from puerperal infection.
The infection spreads through the
lymphatic system or directly through the
fallopian tubes or uterine wall to
peritoneal cavity.
Assessment
Fever
Abdomen is rigid but the remainder is
soft
 abdominal pain
 rapid pulse
 vomiting
Nursing Interventions
To prevent vomiting and rest bowel, the
client needs nasogastric tube.
Intravenous fluid or total parenteral
nutrition is necessary
 the woman will need analgesic for pain
relief
There will be administered large doses of
antibiotics to treat infections.