Puerperal Sepsis

Puerperal sepsis is an infection of the genital tract during the first 6 weeks of pregnancy. It rises as a result of an organism's invasion, incubation, and multiplication and hence does not generally occur until 24 hours or more following delivery. Unless shown differently, puerperal pyrexia is thought to be caused by genital tract infection.

Puerperal pyrexia

Puerperal pyrexia is defined as an increase in temperature of 100°F or more on two distinct times within 24 hours of delivery. In some regions of the world, it is a noticeable ailment.

Puerperal pyrexia can be caused by Puerperal sepsis, UTI, breast problems, infection of laboratory wound, intercurrent infections, thrombophlebitis, tuberculosis, or an unknown cause.

Causes

Infecting organism

The organisms responsible for Puerperal sepsis are the following :

1. Aerobic: Staphylococcus pathogens, escherichia coli, klebsiella, pseudomonas, non-hemolytic streptococcus, Staphylococcus aureus.
2. Anaerobic: Anaerobic streptococcus, bactericides, clostridium welchii, clostridium tetani.
   
   Source of infections
   Endogenous sources: This is frequently caused by an organism that is already present in the patient's vagina and intestine. In normal conditions, the bacteria are non-pathogenic. If the birth canal is lacerated, it can become virulent and pathogenic.
   Exogenous: Organisms from the patient's attendant's respiratory tract and septic foci The main source of infection is dust in the ward's air, which can come through a blanket, sheet, or other item. The majority of hospital personnel have Straphylococcus and streptococci in their respiratory tracts and will easily infect their patients if proper precautions are not implemented.
    
3. Autogenous: In this course, the patient's respiratory tract is the most common source of infection; however, septic foci may also be a source of infection.
4. The predisposing factor

The pathogenicity of the vaginal flora may be influenced by certain factors;

1. Condition that reduces resistance—general or local.
2. The organisms' pathogenicity increased as a result of the conditions encouraging proliferation.
3. External organisms are introduced.
4. Resistance to antibiotics and chemotherapy is becoming more common.

Antepartum factors

• Anemia and malnutrition
• Pre-eclampsia
• Premature membrane rupture very devastating disease sexual intercourse in late pregnancy

Intrapartum factors

• Introgression of sepsis into the upper vaginal tract during the internal inspection, particularly after membrane rupture or during manipulative delivery.
• During labor, there is dehydration and ketoacidosis.
  a violent surgical delivery
• APH and PPH hemorrhaged retained placental tissue and membrane.
• Long-term Previa: the placental location is close to the vagina.
• Extensive perineum, vaginal, and cervix lacerations are substantial risk factors, especially if the laceration is not repaired on time.

Types of Puerperal Sepsis

1. Localized infection
   • There is a small temperature rise, nonspecific malaise, or a headache.
   • The local wound gets puffy and red.
   • Tachycardia, lower abdominal pain, and soreness
   • Pus may occur, causing the wound to be disrupted.
2. Uterine infection
   • There is fluctuating pyrexia with a corresponding rise in pulse rate.
   • Lochia discharge becomes obnoxious, abundant, and frequently red.
   • Subinvoluted, sensitive, and softer than typical uterine.
   • In severe cases, the start is abrupt, with a rapid rise in temperature,
   • typically accompanied by chills and rigors.
3. Spread of infection
   • Spread of the femoral vein, iliac vein, inferior vena cava, fallopian tube, calf muscle thrombophlebitis, and pain on dorsiflexion
   • Peritonitis\Septicemia

Causes

• This could happen within 48 hours of delivery.
• High temperature, confusion, abdominal pain, which may or may not be absent, and joint pain make the patient appear very unwell and toxic.

Prevention

Puerperal sepsis can be avoided to a large extent. Certain precautions should be taken before, during, and after labor.

1. Antenatal
   • Detect and eliminate septic foci, particularly those found in the teeth, gums, tonsils, middle ears, and so on.
   • Maintain and enhance the patient's health status, particularly to raise Hb levels, prevent eclampsia, and treat any anomalies as soon as possible.
   • Vaginal examinations should be kept to a minimum throughout pregnancy, especially in the later months, and should be performed with proper surgical asepsis.
   • Intercourse should be avoided during the last two months to avoid the spread of germs such as streptococcus.
   • The patient should avoid contact with others who have contagious disorders.
   • Personal hygiene should be maintained by the patient.
2. Intra natal
   • To prevent infection, the nurse, doctor, and other workers entering the labor room should wear a mask, gown, and cap.
   • The delivery should be carried out with complete surgical asepsis.
   • The membrane should be preserved for as long as possible.
   • Well managed at every stage of the labor process, which eliminates the danger of infection.
   • To avoid tiredness in the mother, avoid protracted labor.
   • Traumatic vaginal delivery should be avoided, but if necessary, thorough surgical asepsis should be maintained.
   • In the labor room, dust should be avoided.
   • Laceration of the vaginal tract should be healed swiftly and methodically while maintaining perfect homeostasis and performing all necessary aseptic precautions.
   • Excessive blood loss during birth should be replenished as soon as possible with a blood transfusion to increase overall body resistance.
3. Postnatal period
   • Aseptic measures should be observed for at least one week after delivery until the open wound in the uterus and any genital tract injuries have healed.
   • While providing perineal care, the nurse should use aseptic precautions and wear a mask.
   • Limit the number of visits to the ward.
   • To avoid lochia from decomposing and becoming foul on the pad, use sterilized sanitary pads and change them frequently.
   • After each urination and defecation, clean the vulval area with an antiseptic solution.
   • Isolation, as well as barrier nursing techniques, are critical for infected patients and newborns.
   • It is recommended that you refrain from having sexual relations for at least 4-to 6 weeks after giving birth.

Management

• As soon as the patient is diagnosed with puerperal sepsis, she should be isolated and cared for in a separate room.
• To assist in lowering the temperature, use a tepid sponge.
• Items used to care for the mother should be stored separately.
• Determine the source of the fever and treat it accordingly.
• While caring for the mother, midwives must wear a gown and a mask.
• The patient's diet or food must be nutritious and easily digestible.
• Encourage adequate fluid consumption.
• Maintain the patient's personal hygiene by giving perineal care and encouraging oral hygiene.
• Encourage the mother to empty her bladder on a regular basis.
• An intake and output chart should be kept.
• Keep track of vital signs.
• Fundal height and lochia should be measured on a daily basis.
• Inject Ampicillin 2 gm IV every 6 hours or Cefotaxim 1 gram every 8 hours.
• Gentamycin 5mg/kg/body weight injected every 12 hours.
• Metronidazole 500mg/8 hourly IV inj.
• The treatment should be continued for at least 10 days after the infection has been controlled.