puerperal sepsis and urinary tract infection

1. BY:SHALINI JOSHI
M.Sc NURSING Ist year
S.C.O.N. DEHRADUN


2. What these following signs are
indicating?



Redness

3. What are the synonymous words
used for infection and post partum?
Sepsis
 Puerperal


4. Infection that occurs during
postpartum period is termed as?

7. 

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To define puerperal infection
To describe the incidence and common infections
To enlist the causative organism.
To explain predisposing factor
To discuss the mode of infection and pathology
To describe the diagnostic evaluation, prevention
and management
To define the urinary tract infection
To identify the causative organism.
To explain the diagnosis and management

8. 
Puerperal infection is an infection of the
genital tract which occurs as a complication
of delivery.

9. Puerperal infection morbidity affects 2 -10%
of patient.
 5 -10 times higher in caesarean
delivery.
 There is marked decline in puerperal
infection due to:
◦ Improved obstetric care
◦ Availability of wide antibiotic

10. Endometritis
 Endomyometritis
 Endoparametritis


11. Doderlein bacillus (60-70%)
 Yeast like fungus –candida albicans (25%)
 Staphylococcus albus or aureus
 Streptococcus –anerobic common
 Beta hemolyticus streptococcus rare
 E.coli
 Clostridium welchii


13. Pathogenic factor for vaginal flora

the cervicovaginal mucous membrane is damage
even in normal delivery and the uterine surface
too,specially at the placental site
it is converted into open wound by the sepration
of the placenta which takes place during third stage
of labor
the blood clots present at the placental site are
excellent media for the growth of the bacteria.

15. Malnutrition and anemia
 Preterm labor
 Premature rupture of membrane
 Prolonged rupture of membrane


16. Repeated vaginal examination
 Traumatic operative delivery
 Retained bits of placental tissue or membrane.
 Placenta previa- placental site lying close to the
vagina.
 Hemorrhage
 Caesarean delivery


18. 
Puerperal
infection
is
an
wound
infection.the primary sites of the infection
are:◦
◦
◦
◦
Perineam
Vagina
Cervix
Uterus

19. Perineum :Laceration
of the perineum are likely to
infected.
The wound edges become red and swollen.
There may be collection of purulent discharge
resulting in complete disruption of the
wound.
Vagina:Vaginal
laceration are infected directly or by
extension from the perineal infection.
The mucosa is swallon and hyperemic,
resulting in necrosis and sloughing

20. Cervix:The
cervical laceration become the site of
infection
Uterus :The
uterus is most common site of
infection
Decidua is common site and infected first
The infection usually manifests between 3rd
and 6th day of delivery

21.  Putrid
endometritis:-
The
decidua become infected and necrosed
and slough off.
The infection of the deeper myometrium is
prevented by a zone of leukocytic barrier.
The discharge become offensive
Infection spread to distant site may occur when
infection is sever by organism like beta
hemolytic streptococci.

22. 
Pelvic cellulitis:◦ Infection of the pelvic peritoneum and levator
ani muscles.

23. Salpingitis: infection of the fallopian tube and overies
with the formation of tubo ovarian mass
Peritonitis :Lacalised pelvic abscess

24. Thrombophelebitis :Ovarian vein of one side is usually involved
Uterine vein may also involved’
Septicemia and pyemia:These may lead to endocarditis, pericarditis,
Renal abscess, lung abscess, meningitis or
artheritis.
“These are rare these days with advent
of potent antibiotic”

25. Local infectionslight raise in temperature, generalised
malaise and headache.
Redness and the swelling of the local wound
Pus formation and disruption of wound
Uterine infectionPyrexia of variable degree and tachycardia.
Red, copius and offensive lochia.
Subinvoluted, tender and soft uterus.

26. Sever infectionFever with chills and rigor
Rapid pulse
Scanty, odorless lochia
Involuted uterus
 ParemetritisSustained rise in temperature (7th to 10th day)
Constant pelvic pain
Tenderness on either side of the hypogastrium
Unilateral, tender mass felt on vaginal
examination
leukocytosis


27. Pelvic peritonitis:Pyrexia with increased pulse rate
Lower abdominal pain and tenderness
Collection of the pus in pouch of douglas


28. Generalised peritonitis:High fever with rapid pulse
Vomiting
Abdominal pain
Tender and distended abdomen

Thrombophelebitis –
swinging fever with chills and rigor
Features of pyemia


29. SepticemiaHigh temperature with rigor
Rapid pulse
Headache, insomnia or mental confusion
Positive blood culture
Sign/symptoms of infection in the lungs,
meninges or joint


30. Bacteriological studySmear
Culture and antibiotic sensitivity of
purulent material
High vaginal and cervial swabs
Peritoneal fluids
Blood culture


31. Urine :Routine and microscopic examination
Culture if infection is suspected


Complete blood count-

32. UltrasonographyFor diagnosis of pelvic masses
Pelvic abscess
Pelvic peritonitis
Retained bits of placenta and/ or
membrane

33. 
Other specific investigation
X
– ray
Blood for malaria parasite

34.  Antenatal
 Improvement of general condition
 Treatment of septic cocci
 Abstinence from sexual intercourse in the last
two months
 Care about personal hygiene – bathing in dirty
water to be avoided
 Avoiding contact with people having infection,
such as cold, boils.
 Avoiding unnecessary vaginal examinations and
douches in the later months.

35. Intrapartum
 Staff attending on labor client should be free of
infections.

 Full
surgical asepsis to be taken while conducting
delivery
 Women
having respiratory tract infection or skin
infection should be admitted in single room or
separate ward
 Membranes
should be kept intact as long as possible
and vaginal examination should be restricted to
minimum

36.  Traumatic
vaginal delivery and intrauterine
manipulation should be preferably avoided. If required
, should be done using fresh (sterile) gloves with
liberal use of strong antiseptic solution.
 Laceration
of the genital tract should be repaired
promptly and meticulously with perfect homeostasis
 Excessive
blood loss during delivery should be
replaced promptly by transfusion to improve the
general body resistance
 Prophylactic
antibiotic must be administered in cases
of premature rupture of membranes, prolonged labor
or following traumatic delivery.

37.  Postpartum
 Take
aseptic precautions while dressing the
perineal wound
 Restriction of the visitor in the postpartum
ward
 Mothers to be instructed to use sterile
sanitary pads and to change them frequently
 Vulva and perineum to be cleaned with mild
antiseptic solution following urination and
defecation
 Infected mothers and babies are to be isolated
 To keep the floor of the in – patient ward dust
free by frequent mopping.

38. 
The woman should be placed in sterile
room/ward with adequate light and ventilation

Complete rest is to be given in head high
position which help in drainage of lochia and
localization of infection to the pelvis if there is
pelvic peritonitis

Analgesics and sedatives are administered to
enforce rest

39. Treatment cont…




Broad spectrum antibiotics are given IV until
antibiotic sensitivity report are available,
followed by specific antibiotics.
Stool softeners are administered to keep the
keep the bowel open
Anemia to be corrected by blood
transfusion
Infected wound of perineum valva and vagina
are laid open for drainage, cleaned and
dressed with antiseptic preparation.

40. Surgical treatment
The stitches of the perineal wound
may have to be removed to facilitate
drainage of pus and relieve pain.
After the infection is controlled,
secondary sutures may be given later.
 Infected retained product should be removed
as early as possible under cover of antibiotics .
Pelvic abscess should be drained by colpotomy
 Abscess above the poupart’s ligaments should
be incised and the pus drained.


43. It is an infection of the urinary organs
such as kidney, ureter, urinary bladder
and urethra.

44. E. coli
 Klebsiella
 Proteus
 Staphylococcus aureus


45. Other causes are:Recurrence of previous cystitis and pyelitis
 Infection contracted for the first time
during pregnancy is due to : Effect of frequent catheterization either during

labor or in early puerperium to relative
retention of urine.
 Stasis of urine during early puerperium due to
lack of bladder tone and less desire to pass
urine.

46.  It
is one of the common cause of
puesperal pyrexia, the incidence
being 1- 5 % of all deliveries.

47. Raised temperature ( pyrexia)
 Costovertebral angle pain
 Supra pubic discomfort
 Frequent and often painful micturation
 Nausea and vomiting


48. 
UTI is confirmed by examination of an
uncontaminated midstream clean catch
sample for urinalysis and culture and
antibiotic sensitivity test.

49.  High
fluid intake
 Adequate
drainage of urine
 Appropriate
antimicrobial therapy.