PUERPERAL INFECTION Puerperal fever Postpartum fever Puerperal sepsis Childbed fever

DEFINITION :

Bacterial infection following childbirthInfection of the birth canal after the first 24 hours following delivery of a babyTemperature > 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 PROM2. 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 (bnyak VT) Prolonged labor Vaginitis/Cervicitis

ENDOMETRITIS. Intrauterine pressure catheter Low sosioeconomic status Operative vaginal deliveries Poor nutrition Coitus near term

EndometritisClinical findings : Symptoms and Signs : Fever (between 38 oC s/d 40 oC) Soft & tender uterus (lembut & lunak) Lochia foul odor (lochia bau busuk)

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 (perluasan) 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 Perimetritis3. 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 (perlunakan) of the lower abdomen (one or both sides) Tenderness of vaginal examination Fixation uterus by parametrial exudate Mass in broad (luas) ligament

Extension of puerperal infection in pelvic (parametritis)

Septic Thrombophlebitis :

Repeated chills (berulang pd saat dingin) Swings in the temperature (tmperatur naik turun) 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 (nyeri perut hebat) Abdominal rigidity (kekakuan perut) Marked bowel distension Paralytic ileus (kelumpuhan usus )

Treatment : Choice of antibiotics (penicillin + gentamycin) (penicillin + aminoglycosides) (clindamycin + gentamycin) (penicillin + tetracycline) Analgetic Fluid & Electrolyt Operative

PREVENTIVE CARE

1.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