puerperal infection
DESCRIPTION
puerperal infectionTRANSCRIPT
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Sofie Rifayani KrisnadiSofie Rifayani Krisnadi
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PUERPERAL INFECTION
Puerperal fever Postpartum fever
Puerperal sepsis Childbed fever
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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 postpartum
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Predisposing factors1. Antepartum factors
Anemia Nutrition Sexual intercourse PROM
2. INTRAPARTUM FACTORS Iatrogenic introduction of pathogen bacteria (into the birth canal) Trauma (devitalizes tissue)
Hemorrhage
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PATHOLOGY
Decrease of protective mechanism Plasental site = portal of entry The lochia = excellent culture media Ascending infection
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Episiotomy infectionPerineal lacerations infectionLesions of vulva/vagina and cervixdo not occur more often(due to excellent local blood supply)large episiotomy greater riskVaginitis/Servicitis infection during pregnancyBad hygiene
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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
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Episiotomy infection…………
Treatment : Cleaning the wound Promoting formation granulation tissue Debridement (Warm Sitz baths) Perineoraphy
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ENDOMETRITIS
Etiology : PROM Chorioamnionitis Excessive number of vaginal examinations Prolonged labor Vaginitis/Cervicitis
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ENDOMETRITIS…….
Intrauterine pressure catheter Low sosioeconomic status Operative vaginal deliveries Poor nutrition Coitus near term
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Endometritis……………
Clinical findings : Symptoms and Signs : Fever ( between38 oC - 40 oC) Soft & tender uterus Lochia foul odor
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Endometritis………..
LABORATORY FINDINGS :
*Leukocytosis*Urinalysis (pyuria/Bacterial cultures) *Lochia cultures*Sensitivity antimicrobial test
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Endometritis……….
Treatment : Antibiotics ( Aerob & Anaerob m.o) (Ampicillin + Aminoglycosides) (Cephalosporine 2nd/3rd generation) (Clyndamycin) Uterotonic Fowler position Curettage ( retained placenta)
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Extension of Puerperal Infection
1. Extension via superficial epithelization (Percontinuitatum)
Endometritis Salpingitis Pelveoperitonitis Peritonitis
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Extension of Puerperal infection…….
2. Extension via veins Phlebitis --- Sepsis Periphlebitis Parametritis
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4. Extension via Lymphatic
Limphangitis Perilimphangitis Parametritis Perimetritis
Lanjutan
3. Extension via uterine wall
Endometritis Myometritis Perimetritis Parametritis
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Extension of puerperal infection in peritonitis
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Salpingitis :
Most often with postpartum sepsis Gonorrheal salpingitis (rare) infertility
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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
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Extension of puerperal infection in pelvic (parametritis)
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Septic Thrombophlebitis :
Repeated chills Swings in the temperature Hypotension Lasted for many weeks Severe complication :
pneumonitis infarction abscesses septic embolism
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Extension of puerperal infection in peritonitis
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Extension of puerperal infection in pelvic thrombophlebitis.(V.C. = inferior vena cava)
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Peritonitis
Severe abdominal pain Abdominal rigidity
Marked bowel distension Paralytic ileus
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Treatment : Choice of antibiotics (penicillin + gentamycin) (penicillin + aminoglycosides) (clindamycin + gentamycin) (penicillin + tetracycline) Analgetic Fluid & Electrolyt Operative
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PREVENTIVE CARE1. During Pregnancy anemia nutrition genital infection coitus near term
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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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