Management of Infection or Sepsis

Subject: Midwifery I (Theory)

Overview

Sepsis is a potentially fatal condition in which the body fights a serious infection that has spread through the bloodstream. Fever, foul-smelling discharge, prolonged bleeding, general body aching, lower abdomen pain and tenderness with or without rebound tenderness, and so on are signs and symptoms of infection. If a serious infection has gone beyond the uterus or if septicemia is present, sepsis should be handled if severe heavy bleeding occurs in a case of shock. In the case of severe infections affecting deep tissue, give ampicillin 2gm IV every 6 hours, gentamicin 5mg/kg per body weight IV every 24 hours, and metronidazole 500mg IV every 8 hours.

Sepsis is a potentially fatal condition in which the body is fighting a serious infection that has spread through the bloodstream.

Signs and Symptoms

Fever
Foul smell from the discharge
Prolonged bruising
General body ache
Pain and tenderness in the lower abdomen, with or without rebound tenderness

Management of Sepsis

If a severe infection has progressed beyond the uterus or if septicemia has developed, the following steps should be taken:

Management in accordance with the sepsis If very excessive bleeding occurs as a result of shock,
The source of the sepsis is identified.
Antibiotic selection
In severe infections involving deep tissue, use ampicillin 2gm IV every 6 hours, gentamicin 5mg/kg per body weight IV every 24 hours, and metronidazole 500mg IV every 8 hours.
If the injection does not involve deep tissue, give amoxicillin 500mg orally three times per day for five days, metronidazole 400mg orally three times per day for five days, and gentamicin 5mg/kg body weight IV every 24 hours for five days.
Immune protection against tetanus.
There is no need for immune prophylaxis if the lady has been properly inoculated for tetanus within the last 10 years and has a clean, mild wound.
If the woman has been exposed to dirt or feces, has a puncture wound, or has had a burn, a tetanus vaccine booster should be administered.
Tetanus, vaccine, and tetanus antitoxin should be administered if the lady has not been fully immunized for tetanus within the last 10 years or if her immunization status is unknown.
If the retained product of conception is the source of the infection, the uterus should be emptied, preferably by MVA.
Examination of the preserved conceptional product
Referral and transfer: If trained personnel or the necessary supplies and equipment are unavailable, the lady should be transported as soon as possible to a facility where adequate treatment is available.

References

HealthLine. 2005. 2017 http://www.healthline.com/health/sepsis
Mayo Clinic. 1998. 15 January 2016 http://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/dxc-20169787
Medline Plus. 05 January 2017 https://medlineplus.gov/sepsis.html
Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
Postabortion care, a reference manual for improving quality of care, USAID/Nepal, FHD, HMG
Web MD. 2005. 2017 http://www.webmd.com/a-to-z-guides/ss/slideshow-sepsis-101

Things to remember

Sepsis is a potentially fatal condition in which the body is fighting a serious infection that has spread through the bloodstream.
Fever, foul-smelling discharge, prolonged bleeding, general body soreness, and lower abdomen pain and tenderness with or without rebound tenderness are all signs and symptoms of infection.
If a serious infection has gone beyond the uterus or if septicemia is present, sepsis should be treated if severe heavy bleeding occurs in a case of shock.
In severe infections involving deep tissue, use ampicillin 2gm IV every 6 hours, gentamicin 5mg/kg per body weight IV every 24 hours, and metronidazole 500mg IV every 8 hours.
If the retained product of conception is the source of the infection, the uterus should be emptied, preferably by MVA.

Questions and Answers

What are the management of sepsis ?

Management of Sepsis

If severe infection has spread beyond the uterus or if septicemia should be managed by following:

Treatment based on the sepsis if shock results in severe, copious bleeding
Locating the cause of sepsis.
Selecting an antibiotic
Give gentamicin 5 mg/kg per body weight IV every 24 hours, 500 mg of metronidazole IV every 8 hours, and ampicillin 2 gm IV stat every 6 hours in cases of severe infections involving deep tissue.
Give amoxicillin 500 mg orally three times daily, metronidazole 400 mg orally three times daily for five days, and gentamicin 5 mg/kg body weight IV every 24 hours for five days if the injection did not go into deep tissue.
Immune tetanus prophylaxis
There is no need for immune prophylaxis if the woman has received her full tetanus vaccination within the last ten years and has a small, clean wound.
A tetanus vaccine booster should be administered if the woman has a burn, a puncture wound, or is contaminated with dirt or excrement.
Tetanus, vaccine, and tetanus antitoxin should be administered if the woman has not received her full tetanus vaccination within the past ten years or if her vaccination status is unknown.
Uterine evacuation: The uterus should be evacuated, preferably using MVA, if the retained product of conception is what is causing the infection.
Examination of the conceived object that was kept
Referral and transfer: The woman should be moved as soon as possible to a facility with access to the right care in cases where there is a lack of qualified staff or the necessary supplies and equipment.