POST PARTUM INFECTIONS

2 CATEGORY
 1. REPRODUCTIVE SYSTEM INFECTIONS / PUERPERAL
INFECTIONS THAT ARISE IN THE GENITAL TRACT AFTER
DELIVERY.
 2. NON REPRODUCTIVE SYSTEM INFECTIONS THAT ARISE IN
SITES OTHER THAN GENITAL TRACT AND INFLUENCE
MATERNAL MORBIDITY DURING THE POST PARTUM
RECOVERY.
 MASTITIS
 UTI
 INDIRECTLY Related To PREGNANCY, LABOR BIRTH AND LACTATION
 SIGNS AND SYMPTOMS
 FEVER, TACHYCARDIA, CHILLS
 LOCALIZED PAIN
 LOCALIZED REDDENED AREA, WARMTH , TENDERNESS
 PURULENT WOUND DRAINAGE
 LOCHIA: appearance varies depending on causative organism, profuse, scant,
foul odor
 Uterine subinvolution ( uterus boggy, soft fundus, location higher than normal)
 malaise
 REPRODUCTIVE SYS. INFECTION

 38 TEMP AFTER 24 HRS.

 IF WITHIN 24 IS NORMAL DUE TO DEHYDRATION.
 Chlamydia trachomatis – ascended to the uterus from the lower genital tract.
 Antepartum
 Little prenatal care
 Poor nutrition
 Anemia
 Low socioeconomic status
 Premature rupture of membranes
 Chorio amniotic infection
 Sexual intercourse after membranes have a rupture
 Poor female hygiene
 Intrapartum
 Labor
 Frequent vaginal examination (c introduction of pathogens)
 Lack of cleanliness of perineum
 Catheterization
 Prolonged labor
 Prolonged rupture of membranes
 Delivery
 Operative delivery (Cesarian birth, forceps, vacuum)
 Laceration
 Episiotomy
 Hemorrhage
 Intrauterine and fetal monitoring
 Cystitis: Inflammation of Urinary Bladder
 Urinary urgency
 Urinary frequency
 Suprapubic pain
 Dysuria
 Hematuria (not always present)
 Laboratory finding in urine: WBC, RBC, protein
 Pyelonephritis: Inflammation of Kidney(s)

 Fever, chills
 Costovertebral angle tenderness
 Laboratory findings in urine: bacteria, WBC, protein
 Leukocytosis
 Nausea and vomiting
 Mastitis is an inflammation of breast tissue that
sometimes involves an infection. The inflammation
results in breast pain, swelling, warmth and redness. 
 It is most common when a woman is breastfeeding, but
it can happen at other times as well. A clogged milk
duct that doesn't let milk fully drain from the breast, or
breaks in the skin of the nipple can lead to infection.
Key points in education: self-care-home care to
prevent mastitis
 Wash hands thoroughly before breastfeeding
 Maintain breast cleanliness c frequent breast pad change
 Expose nipples to air
 Correct infant latch-on and removal from breast
 Encourage the infant to empty the breast, because milk provides a medium for bacteria growth.
 Frequently breastfeed to encourage milk flow
 If an area of the breast is distended or tender, breastfeed from the infected side first, at each feeding
(express milk remaining in the other breast)
 Massage distended area as the infant nurses.
 Report redness and fever.
 Apply ice packs or moist heat to relieve discomfort.
 THROMBOPHLEBITIS/THROMBOEMBOLISM

 THROMBOPHLEBITIS IS INFLAMMATION THAT OCCURS IN THE VEIN AND CAN OCCUR DURING
THE PRENATAL, INTRAPARTUM, AND POSTPARTUM PHASES OF THE CHILDBEARING CYCLE.

 SUPERFICIAL VENOUS THROMBOSIS LIMITED TO THE SUPERFICIAL VEINS OF THE SAPHENOUS SYSTEM
 DEEP VENOUS THROMBOSIS INVOLVING THE DEEP VEINS OF THE LEG GENERALLY INVOLVES MUCH OF
THE DEEP VENOUS SYSTEM FROM THE FOOT TO THE ILIOFEMORAL REGION.
 DEEP VENOUS THROMBOSIS IN THE POSTPARTUM PERIOD PRESENTS W/ ABRUPT ONSET OF PAIN AND
EDEMA OF THE CALF.
 Important to know: Measures to prevent
Thrombophlebitis
 Avoid prolonged standing or sitting
 Elevate legs when sitting
 Avoid crossing legs (will reduce circulation and encourage venous stasis)
 Exercise such as walking to improve circulation
 Maintain 2500 mL (2 ½ quarts) fluid intake. Prevent hydration, which encourages
sluggish circulation
 Smoking is a risk factor; thus, stop smoking.
 Risk Factor of Thrombophlebitis
 Cesarean birth
 Varicose veins
 Inactivity
 Diabetes mellitus
 Smoking
 Obesity
 History of Thrombophlebitis
 Prolonged standing or sitting
 Prolonged time in stirrups for delivery
 Parity greater than 3
 Maternal age > 35 years of age
 NSG. MGT.
 REST
 SUPPORT HOSE WHEN AMBULATING
 ANALGESIC FOR COMFORT
 ANTICOAGULANT THERAPY ( HEPARIN)
 PROTAMINE SULFATE –HEPARIN ANTIDOTE.
 Advice to stop smoking, smoking is a risk factor for thrombosis and can cause respiratory problems in your
newborn.
 Maintain a daily intake of water to prevent dehydration and consequent sluggish circulation.
 When sitting elevate your legs and avoid crossing them. This will increase the return of venous blood from the
legs.
 Avoid prolonged standing or sitting in one position.
 Improve your circulation with a regular schedule of activity, preferably walking.
 PULMONARY EMBOLISM
 IT OCCURS WHEN FRAGMENTS OF A BLOOD CLOT DISLODGE AND ARE CARRIED TO THE
PULMONARY ARTERY OR ONE OF ITS BRANCHES.
 THE EMBOLISM CAN OCCLUDE THE VESSEL AND OBSTRUCT THE FLOW OF BLOOD INTO
THE LUNGS. IF THE EMBOLISM IS SMALL, ADEQUATE PULMONARY CIRCULATION MAYBE
MAINTAINED UNTIL TREATMENT CAN BE INITIATED.
 LARGE PULMONARY EMBOLISM MAY BLOCK BLOOD FLOW FROM THE RIGHT VENTRICLE
INTO THE LUNGS.
 IF THE PULMONARY CIRCULATION IS SEVERELY COMPROMISED, DEATH MAY OCCUR.
S/S

 CHILLS
 HYPOTENSION
 ABDOMINAL PAIN
 DYSPNEA
 CHEST PAIN
NSG. MGT.

 SEMI FOWLERS POSITION

 OXYGEN BY FACEMASK
 IV FLUID INFUSION
 PULSE OXIMETER
 VS
 ABG
 HEPARIN
 PULMONARY ARTERY CATHETER
 DOPAMINE
 MORPHINE
 POST PARTUM BLUES
 During post partal period as many as 50% of patients experience
some feelings of overwhelming sadness or baby blues. (Dimes
2017)
 1 to 10 days postpartum
 Feeling of sadness postpartum blues
 They may feel let down and irritable, Due to hormonal changes, a
decrease in estrogen, progesterone and gonadotrophic releasing
hormone declines that occurred with delivery of the placenta.
 Breastfeeding has been shown to help elevate baby blues and counteract the effects of hormonal drop
that occurs after childbirth.
 It may be a response to dependence and low self-esteem caused by exhaustion
 Being away from home
 Physical discomfort
 Tension engendered by assuming a new role, especially if they are not receiving support from their
partner.
 Syndrome is evidenced by feelings of inadequacy, mood lability, anorexia and sleep disturbance.
 Normal response
 Feelings can be exacerbated by some factors;
 Problems at home ( ill parents, other child)
 Partner employment not stable
 Natural disaster
 Not normal PPD Postpartum Depression
 Overwhelming sadness
 Extreme fatigue
 An inability to stop crying
 Increased anxiety about their own and infants health
 Insecurity ( unwillingness to be left alone and inability to make decisions
 Psychosomatic symptoms
 Nausea
 Vomiting, diarrhea

Extreme mood fluctuations

Risk factors for PPD

 History of depression
 Troubled childhood
 Low self esteem
 Stress in the home and work
 Lack of effective support
 Different expectations between partners
 Feeling of disappointment related to the birth and / or child-rearing experiences.
 NSG MGT FOR PPD
 Difficult to predict who will develop postpartum depression before birth, thus in the postpartum
period discovery is the priority.
 Anticipatory guidance and individualized support from the health care provider.
 Give the birthing parents the chance to verbalize their concerns/ feelings.
 Help to gain a sense of control and move through these emotions.
 Can be handled best with discussion and concerned understanding and those that should be
referred out for additional support
 Antidepressant therapy
 MGT FOR POST PARTUM PSYCHOSIS

 STAY WITH THE CLIENT TO AVOID SELF HARM

 DO NOT LEAVE THE PT. ALONE BECAUSE THEY MIGHT HARM THE INFANT AS WELL.
 Monitor for adverse effects (e.g. hypotension, suicidal thoughts, cardiac arrhythmias, etc). Evaluate patient
understanding on drug therapy by asking the patient to name the drug, its indication, and adverse effects to watch for.
Monitor patient compliance to drug therapy.
 Citalopram (Celexa)
 Escitalopram (Lexapro)
 Fluoxetine (Prozac)
 Paroxetine (Paxil)
 Sertraline (Zoloft)
 POST PARTUM PSYCHOSIS
 HAS LOST CONTACT WITH REALITY, MAY DENY THEY HAVE A CHILD, CHILD WAS
BROUGHT TO THEM, INSIST NEVER PREGNANT.
 IF IT OCCURS OR COINCIDES WITH THE POST PARTUM PERIOD
 A RESPONSE TO THE CRISIS OF CHILDBEARING, THE MAJORITY HAS SYMPTOMS OF
MENTAL ILLNESS BEFORE PREGNANCY. IT COULD BE PRECIPITATED BY THE SYNDROME
OR SYMPTOMS PRESENTED, RECURRENCE.
 EXCEPTIONALLY SAD
 Birthing parents are greater risk for moderate to severe postpartal
depression PPD after childbirth and require formal counselling esp ,
 Economically stressed
 Comorbid condition ( DM)

 PPD has implications for both patients and newborns and families.
 POST PARTUM BLUES AND DEPRESSION
 POST PARTUM BLUES- mildest form, describes the observed and transient experience of weepiness,
mood changes, anxiety, and irritability frequently observe past tense in the first few days following
childbirth. It is usually self-limiting but should not resist beyond 10-14 days because postpartum blues is
commonly a biological cause rather than a psychological one.
 Tx: Estrogen patch

 Marital conflict only definable link of b/w postpartum blues and progression to postpartum depression.
 The depressive symptoms include sadness, crying, exhaustion,
irritability, anxiety, decreased sleep, decreased concentration,
and labile mood

 A woman experiencing postpartum depression often has a profound

sense of incapacity to love her family and the feeling of ambivalence,
to ward her infant.
 Empathy, understanding, and reassurance are an important component
 Psychiatrist and antidepressant
 POST PARTUM PSYCHOSIS – severe one
Thank you future nurses
for the whole semester
hope you learned