Managing Complications in Postpartum Period:

Puerperal Sepsis
 Learning Objectives
By the end of this session, the learners will be able to:
• Define maternal/puerperal sepsis
• Enumerate the risk factors for maternal sepsis
• Explain ways to prevent sepsis
• Describe the causes, symptoms, signs and management of sepsis
• List the indications for antibiotics in mother
• Discuss the GoI’s recommendation of broad spectrum antibiotics

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 Puerperal Sepsis is a Leading Cause of Maternal
Death in Postpartum Period
Puerperal sepsis can be
prevented and managed by:
• Maintaining hygiene and hand
Others 31% Haemorrhage washing and following strict
27%
infection prevention practices
before handling mother
Sepsis 11% • Reducing frequent PV
Abortion 8% examination during labour
• Early identification and
Obstructed judicious use of antibiotics in
Hypertensive
labour 9%
disorders 14%
mothers showing signs of
Source- WHO 2014 infection

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 Diagnosis
Maternal sepsis:
Maternal sepsis in general also called Puerperal Sepsis is
an infection of the genital tract at any time between the
onset of rupture of membranes or labour and the 42nd
day following delivery or abortion in which any two or
more of the following signs and symptoms are present:
• Fever of >100.5 Fahrenheit (>38ºC)
• Abnormal, Foul smelling vaginal discharge
• Lower abdominal pain
• Subinvoluted uterus which is tender

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 Risk Factors
Client-related (Maternal)
• Pre-existing STIs/RTIs
• Not immunized against tetanus
• Pre-existing diabetes
• Poor patient hygiene
• Pre-existing anaemia and
malnutrition
Related to delivery
• Failure to follow Infection
prevention practices
• Poor monitoring of mother during
and after labour
• Frequent vaginal examinations
• PROM >18 hrs
• Prolonged/obstructed labour >24
hrs
• C-section/ Instrumental delivery
• Manipulations high in the birth canal
• Dead tissue in the birth canal
• Unrepaired vaginal/cervical
lacerations
• PPH 5
 Prevention of Maternal Infection
Puerperal sepsis is to a great extent preventable
Measure to be taken in
Before and during delivery After delivery:

• Emotional support by allowing • Maintain perineal hygiene

companion • Use of clean sanitary pads
• Use of partograph to avoid prolonged
labor
• Limit vaginal examination
• Asepsis during delivery
 6 CLEANS
 Hand washing, HLD gloves,
instruments and equipment
• Delivery by trained personnel

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 Principles of Management of Puerperal Sepsis
Measure Vital Signs

Patient is non-toxic i.e. low grade fever and Patient is toxic i.e. high grade fever
pulse not rapid (between 90-100/min) and rapid pulse (>100/min)

• Admit the patient • Start IV fluids

• Start oral fluids • Start IV antibiotics
• Blood and urine for routine and • Rule out presence of retained
microscopic examination bits of placenta
• Start oral antibiotics
• Rule out presence of retained
bits of placenta
• Monitor vitals every 2 hourly Refer to FRU
• Watch for 24 hours

If vitals improving, then complete

course of antibiotics for 5 days If vitals not improving, refer to FRU
 Recommended Antibiotic to Mother

Not very Sick Mother Very Sick Mother

Ampicillin 1 gm - 6 hourly Ampicillin 1 gm - 6hrly

oral Intravenous
Metronidazole 400mg - 8 Metronidazole 500mg –IV 8
hourly oral hourly
Gentamycin 80 mg, BD Intra Gentamycin 80 mg, BD Intra
Muscularly Muscularly

If mother is well enough to take oral medicine, administer drugs

orally only

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 Key messages

• Puerperal sepsis is one of the leading causes of

maternal deaths
• Puerperal sepsis is to a great extent preventable
• Antibiotics should be given to the woman only if
they are indicated
• At periphery, ANM should identify the indications for
antibiotics and give first dose before referral