Tuesday, December 5, 2017

Puerperal sepsis

PUERPERAL SEPSIS

Puerperal sepsis is any bacterial infection of the genital tract which occurs after the birth of a baby. It is usually more than 24 hours after delivery before the symptoms and signs appear.

Some of the most common bacteria are:
Streptococci
Staphylococci
Escherichia coli (E.coli)
Clostridium tetani
Clostridium welchii
Chlamydia
Gonococci

SYMPTOMS AND SIGNS 
Fever (temperature of 38°C or more)  Chills and general malaise
Lower abdominal pain
Tender uterus
Subinvolution of the uterus
Purulent, foul-smelling lochia.
Slight vaginal bleeding
Shock.

RISK FACTORS
Some women are more vulnerable to puerperal sepsis, including anaemia and/or malnourished, protracted labour, prolonged rupture of the membranes, frequent vaginal examinations, a traumatic delivery, caesarean section and retained placental fragments, PPH, diabetes all predispose to puerperal infection.

SITES
The most common site of infection in puerperal sepsis is the placental site.
Other sites of infection are abdominal and perineal wounds following surgery and lacerations of the genital tract, e.g. cervix, vagina and perineum.

Following delivery, puerperal sepsis may be localized in the perineum, vagina, cervix or uterus.
Infection of the uterus can spread rapidly if due to virulent organisms, or if the mother’s resistance is impaired.
It can extend beyond the uterus to involve the fallopian tubes and ovaries, to the pelvic cellular tissue causing parametritis , to the pelvic peritoneum, causing peritonitis , and into the blood stream causing septicaemia

DIFFERENTIAL DIAGNOSIS
Fever  in the puerperium can also be caused by:  urinary tract infection (acute pyelonephritis)  wound infection (e.g. scar of caesarean section)  mastitis or breast abscess  thrombo-embolic disorders, e.g. thrombophlebitis or deep vein thrombosis  respiratory tract infections.

-Md Mobarak Hussain (Maahii)

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