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Puerperal Infection

Puerperal (childbed) fever is a bacterial infection of the birth canal occurring within the first 10 days after delivery. It is caused by pathogens entering the birth canal during labor or delivery, often due to poor hygiene or medical procedures. Left untreated, it can spread from the uterus and fallopian tubes to the pelvis and peritoneum, causing endometritis, pelvic inflammatory disease, pelvic cellulitis, thrombophlebitis, and even sepsis. Prevention focuses on nutrition, treating infections before delivery, clean delivery practices, and hygiene during the postpartum period.

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536 views28 pages

Puerperal Infection

Puerperal (childbed) fever is a bacterial infection of the birth canal occurring within the first 10 days after delivery. It is caused by pathogens entering the birth canal during labor or delivery, often due to poor hygiene or medical procedures. Left untreated, it can spread from the uterus and fallopian tubes to the pelvis and peritoneum, causing endometritis, pelvic inflammatory disease, pelvic cellulitis, thrombophlebitis, and even sepsis. Prevention focuses on nutrition, treating infections before delivery, clean delivery practices, and hygiene during the postpartum period.

Uploaded by

putri1114
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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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

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