PUERPeral Sepsis

1. Define puerperal sepsis.
2. What are the predisposing factors and clinical features of puerperal

sepsis?
3. Write down the treatment of puerperal sepsis
4. What are the physiological changes occur during puerperium?
5. Explain the important physiological assessment need to do during the
immediate postnatal period.
Ans:
1. Puerperal sepsis, also known as postpartum sepsis, is a bacterial infection

that occurs after childbirth, usually within the first six weeks. It typically
arises from an infection in the genital tract, often due to complications
during delivery or inadequate postpartum hygiene. Symptoms include
fever, abdominal pain, and abnormal vaginal discharge, and if left
untreated, it can lead to severe complications or even death.
2. The predisposing factors are:
Antepartum risk factors:
(1) Anemia;
(2) Preterm labor
(3) Premature rupture of the membranes
(4) Prolonged rupture of membrane (≥18 hours)
(5) Diabetes
(6) Immunocompromised (HIV).
Intrapartum risk factors:

(1) Repeated vaginal examinations
(2) Traumatic vaginal delivery
(3) Hemorrhage-antepartum or postpartum
(4) Retained bits of placental tissue or membranes
(5) Prolonged labor
(6) Obstructed labor
(7) Cesarean delivery
(8) Dehydration and ketoacidosis during labor
Clinical features of puerperal sepsis:

SIGNS AND SYMPTOMS
 Local infection
 Uterine infection
 Spreading of infections
LOCAL INFECTION (WOUND INFECTION)
 rise of temperature
 generalized malaise
 Headache
 local wound becomes red and swollen (PRISH)
 Pus
 chills and rigor
 Sero purulent discharge.
UTERINE INFECTION
 Mild-rise in temperature (> 100.4 deg * F )

 Rise in pulse rate (>90)
 Lochial discharge becomes offensive and copious
 The uterus is subinvoluted and tender(may be due to lochiostasis and
lochiometra).
 Severe-high rise of temperature
 chills and rigor
 Pulse rate is rapid
 Breathlessness
 Abdominal pain
 Dysuria
 Lochiorrhea, green colour and foul odor
 Uterus may be subinvoluted, tender
SPREADING INFECTION
 Extra uterine spread

 Evident by presence of :
 Pelvic tenderness (pelvic peritionitis)
 Tenderness on the fornix (parametritis)
 Bulging fluctuant mass in the pouch of douglas (pelvic abscess)
3. The treatment of puerperal sepsis

 Medical management
 Surgical management
 Nursing management
Medical management
Antibiotics
Ideal antibiotic regimen should depend on the culture and sensitivity

report.
• Gentamicin (1.5mg/kg/8 hourly) + Clindamycin (900mg/8 hourly)
• Metronidazole (500mg / 8 * hr) - for anaerobic group
Antibiotic Regimens- (severe sepsis)
A combination of either piperacillin-tazobactam or carbapenem +

clindamycin
• Women with MRSA infection should be treated with vancomycin or
teicoplanin.
Surgical management
 Perineal wound
 Surgical evacuation
 Colpotomy
 Laparotomy
 Hysterectomy
Perineal wound
 Removal of stitches of perineal wound

 Wound is cleaned with sitz bath, dressed with an antiseptic
ointment/powder
 After infection is controlled, secondary suture is given.
Retained uterine products
 Diameter < 3cm , left alone

 To avoid the risk of septicemia, surgical evacuation is done after
antibiotic coverage for 24 hours.
 Septic pelvic thrombophlebitis, treated with IV heparin for 7- 10
days.
Pelvic abscess
 Drained by colpotomy under ultrasound guidance.
Wound dehiscence
 Dehisence of episotomy or abdominal wound following cesarean

section
 Managed by:
1. scrubbing wound twice daily,
2. Debridement of necrotic tissues
3. Closing the wound with secondary tissue
4. Antimicrobials
Hysterectomy
• Rupture or perforation
• Mutiple abscesses
• Gangrenous uterus
• Gas gangrene infection
NURSING MANAGEMENT
The nursing management of clients with puerperal infection includes

preventing the control spread of infection, promoting healing, and
improving the attachment/bonding of parent and infant.
Nursing diagnosis
 Risk For Infection
 Acute Pain
 Risk For Altered Parent-Infant Attachment
 Imbalanced Nutrition: Less Than Body Requirements
Risk For Infection
 Demonstrate and maintain a strict hand-washing policy for staff,

client, and visitors.
 Demonstrate correct perineal cleaning after voiding and
defecation, and frequent changing of peripads.
 Demonstrate proper fundal massage.
 Monitor oral/parenteral intake, stressing the need for at least
2000 ml fluid per day
 Monitor temperature, pulse, and respirations. Note presence of
chills or reports of anorexia or malaise.
 Observe perineum/incision for other signs of infection (e.g.,
redness, edema, ecchymosis, discharge and approximation).
 Note subinvolution of uterus, extreme uterine tenderness.
 Encourage semi-Fowler's position.
Acute Pain
 Assess location and nature of discomfort or pain, rate pain on a 0-
10 scale.
 Provide instruction regarding, and assist with, maintenance of
cleanliness and warmth.
 Instruct client in relaxation techniques; provide diversionary
activities such as radio, television, or reading.
 Encourage continuation of breastfeeding as client's condition
permits.
 Change client's position frequently. Provide comfort measures;
e.g., back rubs, linen changes.
 Encourage the woman to ask for pain medications before the pain
becomes severe/intolerable.
 Apply local heat using sitz bath if indicated.
 Administer analgesics or antipyretics.
Risk For Altered Parent- Infant Attachment
 Monitor client's emotional responses to illness and separation

from infant, such as depression and anger. Encourage client to
verbalize feelings
 Observe maternal-infant interactions
 Provide opportunities for maternal-infant contact whenever
possible.
 Encourage father or other family members to care and interact
with the infant.
Imbalanced Nutrition: Less Than Body Requirements

 Discuss eating habits including, food preferences and
intolerances.
 Promote intake of at least 2000 ml/day of juices, soups, and other
nutritious fluids.
 Encourage choice of foods high in protein, iron, and vitamin C
when oral intake permitted.
 Encourage adequate sleep/rest.
 Administer iron preparations and/or vitamins, as indicated.

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1. Define puerperal sepsis.

2. What are the predisposing factors and clinical features of puerperal

1. Puerperal sepsis, also known as postpartum sepsis, is a bacterial infection

Intrapartum risk factors:

Clinical features of puerperal sepsis:

LOCAL INFECTION (WOUND INFECTION)

 Mild-rise in temperature (> 100.4 deg * F )

 Extra uterine spread

3. The treatment of puerperal sepsis

Ideal antibiotic regimen should depend on the culture and sensitivity

• Gentamicin (1.5mg/kg/8 hourly) + Clindamycin (900mg/8 hourly)

• Metronidazole (500mg / 8 * hr) - for anaerobic group

Antibiotic Regimens- (severe sepsis)

A combination of either piperacillin-tazobactam or carbapenem +

 Removal of stitches of perineal wound

Retained uterine products

 Diameter < 3cm , left alone

 Drained by colpotomy under ultrasound guidance.

 Dehisence of episotomy or abdominal wound following cesarean

1. scrubbing wound twice daily,

2. Debridement of necrotic tissues

3. Closing the wound with secondary tissue

• Gas gangrene infection

The nursing management of clients with puerperal infection includes

Risk For Infection

 Demonstrate and maintain a strict hand-washing policy for staff,

Risk For Altered Parent- Infant Attachment

 Monitor client's emotional responses to illness and separation

Imbalanced Nutrition: Less Than Body Requirements

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