Sofie Rifayani KrisnadiSofie Rifayani Krisnadi

PUERPERAL INFECTION

Puerperal fever 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 postpartum

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

PATHOLOGY

Decrease of protective mechanism Plasental site = portal of entry The lochia = excellent culture media Ascending infection

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

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 ( between38 oC - 40 oC) 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 Curettage ( retained placenta)

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

4. Extension via Lymphatic

Limphangitis Perilimphangitis Parametritis Perimetritis

Lanjutan

3. Extension via uterine wall

Endometritis Myometritis Perimetritis 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.(V.C. = inferior vena cava)

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 CARE1. 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