PRESENTED BY : MS. VRUTI PATEL,F.Y.M.SC. NURSING,SCN

INTRODUCTION

worldwide, more than 500 000 women die of complications of pregnancy and childbirth.

PUERPERAL PYREXIA

DEFINITION

A rise of temperature reaching 100.4˚F (38˚C) or more (measured orally) on separate occasions at 24 hours apart (excluding first 24 hours) within first 10 days following delivery is called puerperal pyrexia.

Puerperal fever or childbed fever in the 18th and 19th centuries affected, on average, six to 9 women in every 1,000 deliveries, killing two to three of them with peritonitis or septicemia.

CAUSES

• PPD 0: ATELECTASIS– general anesthesia– cigarette smoking– obstructive lung disease

• PPD 1-2: URINARY TRACT INFECTIONS

- Multiple catheterization during labor

- Multiple vaginal examinations during labor

- Untreated bacteriuria

CONTI…

• PPD 2-3: ENDOMETRITIS Emergency cesarean section Prolonged membrane rupture Prolonged laborMultiple vaginal examinations during labor

• PPD 4-5: WOUND INFECTION

CONTI…

• PPD 5-6: SEPTIC PELVIC THROMBOPHLEBITIS Emergency cesarean section Prolonged membrane rupture Prolonged labor Diffuse difficult vaginal delivery

• PPD 7-21: MASTITIS Nipple trauma from breastfeeding

CLINICAL FINDINGS AND MANAGEMENT

PUERPERAL SEPSIS

Definition :

An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis.

PREDISPOSING FACTORS

Antepartum factors :

•Malnutrition and anaemia

•Preterm labor

•Premature rupture of the membrane

•Chronic deliberating illness

•Prolonged rupture of the membrane

Intrapartum factors :•Repeated vaginal examination•Prolonged rupture of the membranes•Dehydration and keto-acidosis during labor•Traumatic operative delivery•Haemorrhage - antepartum or postpartum•Retained bits of the placental tissue or membranes•Placental praevia – placental site lying close to the vagina•Caesarean delivery

CAUSES

SIGNS AND SYMPTOMS

• Fever which occurs within 24 hours or more is the first sign

• Increased Pulse rate • The uterus is sub-involuted, tender and softer

than usual• Foul smelling vaginal discharge• Local pain and swelling of the infected suture

line• Headache, insomnia and anorexia

In severe sepsis :•Constant pelvic pain•Rise in temperature with increased pulse rate•Lower abdominal pain•Intense pain which worsens the condition of the patients•Severe infection of the fallopian tubules•Collection of pus in the pouch of doughles

INVESTIGATION• History• Clinical examination• High vaginal and endocervical swabs for culture• Mid stream urine for analysis and culture• Blood for total and differential count,

haemoglobinestimation• Blood culture if fever is associated with chills and

rigor• Pelvic ultrasound• X-ray chest• Blood urea and electrolytes

PROPHYLAXIS

TREATMENT1. Isolation

2. Ventilation

3. Intake

4. Proper rest

5. Mild laxatives

6. Vital signs

7. Regular bathing or sponging

8. Aseptic dressing

9. Vaginal pads

10.Antibiotics

11.Resuscitative procedures

SURGICAL INTERVENTION

1.Open and drain infected episiotomy

2.Clot removal or by-pass

3.Prompt and aggressive exploration and debridement of necrotic tissue

4.Hysterectomy