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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