| ID | 347 |
|---|---|
| Name | PUERPERAL SEPSIS (Birth Canal Infection) |
| Cause | Anaemia prolonged labour frequent vaginal examinations in labour under unsterilized circumstances premature rupture of membranes for prolonged period |
| Signs Symptoms | Fever and other symptoms like pelvic pain foul smelling vaginal discharge and delayed reduction of the uterine size |
| Diagnosis | Diagnosis: 1. Clinical examination-abdomen & perineum. 2. Laboratory tests - a. Vaginal swab culture. b. Urine culture. c. Blood culture. d. Culture and sensitivity test. |
| Investigations | Complete blood count. Electrolytes. Blood cultures, if sepsis is suspected. Urinalysis, with cultures and sensitivity tests. Cervical or uterine cultures. Wound cultures, if appropriate. Lactate, if sepsis suspected. |
| Management | Admit the patient. Start oral fluids. Blood and urine for routine and microscopic examination. Start oral antibiotics. Rule out presence of retained bits of placenta. Monitor vitals every 2 hourly. Watch for 24 hours. |
| Introduction | |
| History | |
| Etiology | See unde cause |
| Clinical Features | Clinical features: 1. Fever. 2. Fever may be accompanied by rigor. 3. Pulse rate raised. 4. Patient feels hot with headache and backache. 5. If infection spreads to the pelvic peritonium-abdominal pain and tenderness develops. 6. In cases of general peritonitis- the patient is severly ill, with a rapid-thready pulse, abdominal pain, distention, voming and diarrhoea, and genralized tenderness. 7. In septicemia- there is high fever with rigor, patient is very ill and there may be no localizing signs. |
| Preventions | Maintaining hygiene and hand washing and following strict infection prevention practices before handling mother. Reducing frequent PV examination during labour. Early identification and judicious use of antibiotics in mothers showing signs of infection. |
| Treatment | Treatment: 1. The patient must be isolated and should be hospitalized. 2. Good nursing care. 3. Analgesics for pain- paracetamol 1 tab. t.d.s. 4. Sedatives to ensure rest- diazepum 5mg H/S. 5. Adequate fluid intake. 6. Transfusion of blood may be required. 7. Antibiotic treatment according to culture and sensitivity test, but before getting the report of C/S test, can start with co-trimoxazole, amoxycillin, or cephalosporin (broad spectrum antibiotic) and subsequently modified if necessary. 8. If there is an infected perineal wound the stitches should be removed. 9. If there is any infected piece of placenta- uterine cavity should be explored to remove it. 10. If there is a plevic abscess- it is to be drained. 11. Pelvic cellulitis also needs drainage. |
| Complications | Endotoxic shock peritonitis, abscess formation, generalized sepsis, and death. Long-term complications of secondary infertility and chronic disabilities are also associated with this condition |
| Prognosis | |
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| Classification | |
| Observation | |
| Pathology |
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