Puerperal Sepsis

b.sc nursing obg assignment on topic puerperal sepsis with refrences

1. Introduction

Puerperal sepsis, also known as postpartum sepsis, is a bacterial infection of the genital tract occurring after childbirth or abortion, usually within 42 days of delivery. It remains a significant cause of maternal morbidity and mortality, especially in developing countries.
According to the World Health Organization (WHO), puerperal sepsis contributes to approximately 10–15% of maternal deaths worldwide. Early detection and prompt treatment are crucial for saving the mother’s life.

2. Definition

According to WHO (2010):
“Puerperal sepsis is infection of the genital tract occurring at any time between the rupture of membranes or labor and the 42nd day postpartum, in which two or more of the following symptoms are present: pelvic pain, fever (≥38°C), abnormal vaginal discharge, and delayed uterine involution.”

3. Incidence

• Global incidence: Around 11% of maternal deaths are due to puerperal sepsis.
• In India, it accounts for 10–12% of maternal mortality.
• Higher rates are observed in rural and low-resource settings due to unhygienic delivery practices and poor postnatal care.

4. Etiology (Causes)

1. Causative Organisms:
   • Streptococcus pyogenes (Group A Streptococcus)
   • Staphylococcus aureus
   • Escherichia coli
   • Clostridium welchii
   • Klebsiella, Proteus, Pseudomonas, and anaerobic bacteria.
2. Sources of Infection:
   • Exogenous: Contaminated hands, instruments, or dressings used during delivery.
   • Endogenous: Infection from the mother’s own vagina or cervix.

5. Predisposing Factors

1. Prolonged labor or premature rupture of membranes
2. Repeated vaginal examinations
3. Retained products of conception
4. Operative or instrumental deliveries
5. Anemia and malnutrition
6. Poor perineal hygiene
7. Low socioeconomic status
8. Unsterile delivery conditions

6. Pathophysiology

1. Entry of pathogens through the genital tract after delivery.
2. Infection spreads to:
   • Endometrium → Endometritis
   • Myometrium → Myometritis
   • Parametrium → Parametritis or Pelvic cellulitis
   • Peritoneum → Peritonitis
   • Bloodstream → Septicemia
3. The infection leads to inflammation, tissue necrosis, and systemic infection if untreated.

7. Clinical Manifestations

1. Fever ≥ 38°C within 24–48 hours postpartum
2. Chills and rigors
3. Lower abdominal or pelvic pain
4. Foul-smelling, purulent lochia
5. Subinvolution of uterus (uterus fails to shrink properly)
6. Tachycardia and malaise
7. Pelvic tenderness
8. Signs of septicemia (hypotension, confusion, oliguria)

8. Types of Puerperal Infection

Type	Site of Infection	Example
Localized	Perineum, vagina, cervix	Perineal wound infection
Endometrial	Endometrium	Endometritis
Parametrial	Connective tissue	Pelvic cellulitis
Peritoneal	Pelvic peritoneum	Pelvic peritonitis
Systemic	Bloodstream	Septicemia

9. Investigations

1. Complete blood count (↑ WBC, neutrophilia)
2. Blood culture and sensitivity
3. High vaginal and endometrial swab for culture
4. Urine examination
5. Ultrasound of pelvis (to detect retained products of conception)
6. C-reactive protein (CRP) and ESR elevated

10. Management

A. Medical Management

1. Antibiotic therapy:
   • Broad-spectrum antibiotics such as:
     • Ampicillin + Gentamicin + Metronidazole
     • Clindamycin + Gentamicin (alternative)
2. Antipyretics: Paracetamol for fever and pain relief.
3. IV fluids: To prevent dehydration and maintain circulation.
4. Uterotonics: Oxytocin to promote uterine contraction and drainage of lochia.
5. Removal of source: Evacuation of retained products if present.

B. Surgical Management

1. Drainage of abscess if developed.
2. Hysterectomy in severe, unresponsive cases.

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11. Nursing Management

Assessment:

1. Monitor vital signs every 4 hours.
2. Observe for foul-smelling lochia and uterine tenderness.
3. Monitor fluid balance and urine output.

Nursing Diagnoses:

1. Hyperthermia related to infection.
2. Acute pain related to uterine infection.
3. Risk for deficient fluid volume related to fever and infection.
4. Anxiety related to fear of complications.
5. Deficient knowledge regarding personal hygiene and infection prevention.

Nursing Interventions:

1. Maintain aseptic technique during perineal care.
2. Encourage fluid intake (2–3 liters/day).
3. Administer antibiotics and antipyretics as prescribed.
4. Provide perineal hygiene and change pads frequently.
5. Educate mother about hand hygiene, perineal care, and danger signs.
6. Provide emotional support and reassurance.

12. Complications

1. Pelvic abscess
2. Septicemia
3. Shock
4. Peritonitis
5. Infertility due to tubal blockage
6. Death (if untreated)

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13. Prevention

1. Aseptic precautions during delivery and postpartum period.
2. Proper handwashing and sterilization of instruments.
3. Timely management of prolonged labor or premature rupture of membranes.
4. Good perineal and personal hygiene.
5. Early detection and prompt treatment of infections.
6. Health education on postnatal care.

14. Prognosis

With early diagnosis and adequate antibiotic therapy, the prognosis is generally good. However, delayed or untreated cases can result in life-threatening complications like septicemia and shock.

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15. Conclusion

Puerperal sepsis remains a preventable cause of maternal death. The role of nurses is vital in early detection, proper aseptic technique, and health education. Through effective antenatal and postnatal care, this condition can be largely eliminated, ensuring safer motherhood and reducing maternal mortality.

16. References

1. D.C. Dutta’s Textbook of Obstetrics.
2. Park K. Preventive and Social Medicine, 27th Edition.
3. WHO Guidelines on Prevention and Treatment of Puerperal Infections (2015).
4. Konar, H. DC Dutta’s Textbook of Obstetrics including Perinatology and Contraception.

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