CLASS TEACHING

BY:-SHALINI JOSHIM.Sc NURSING Ist yearS.C.O.N. DEHRADUN

What these following signs are indicating?

RednessSWELLINGRaised temperatureRapid and weak pulseHypotension Increased leukocyte count

What are the synonymous words used for infection and post partum?

SepsisPuerperal

Infection that occurs during postpartum period is termed as?

Puerperal infection or puerperal sepsis

U.T.I. IS STAND FOR?

Urinary tract infection

PUERPERAL INFECTION

URINARY TRACT INFECTION

To define puerperal infectionTo describe the incidence and common infectionsTo enlist the causative organism.To explain predisposing factorTo discuss the mode of infection and pathologyTo describe the diagnostic evaluation, prevention

and managementTo define the urinary tract infectionTo identify the causative organism.To explain the diagnosis and management

DEFINITION :-Puerperal infection is an infection of the

genital tract which occurs as a complication of delivery.

INCIDENCE Puerperal infection morbidity affects

2 -10% of patient.5 -10 times higher in caesarean

delivery.There is marked decline in puerperal

infection due to:-◦Improved obstetric care◦Availability of wide antibiotic

COMMON PUERPERAL INFECTIONS

Endometritis EndomyometritisEndoparametritis

CAUSATIVE ORGANISM

Doderlein bacillus (60-70%)Yeast like fungus –candida albicans

(25%)Staphylococcus albus or aureusStreptococcus –anerobic commonBeta hemolyticus streptococcus rareE.coli Clostridium welchii

PREDISPOSING FACTOR

Pathogenic factor for vaginal flora

the cervicovaginal mucous membrane is damage even in normal delivery and the

uterine surface too,specially at the placental site

it is converted into open wound by the sepration of the placenta which takes place

during third stage of labor

the blood clots present at the placental site are excellent media for the growth of the bacteria.

ANTEPARTUM FACTORMalnutrition and anemiaPreterm laborPremature rupture of membraneProlonged rupture of membrane

INTRAPARTUM FACTOR

Repeated vaginal examinationTraumatic operative deliveryRetained bits of placental tissue or

membrane.Placenta previa- placental site lying

close to the vagina.Hemorrhage Caesarean delivery

MODE OF TRANSMISSION

PATHOLOGYPuerperal infection is an wound

infection.the primary sites of the infection are:-◦Perineam◦Vagina◦Cervix◦Uterus

Perineum :-Laceration of the perineum are likely

to infected.The wound edges become red and

swollen.There may be collection of purulent

discharge resulting in complete disruption of the wound.

Vagina:-Vaginal laceration are infected

directly or by extension from the perineal infection.

The mucosa is swallon and hyperemic, resulting in necrosis and sloughing

Cervix:-The cervical laceration become the

site of infection

Uterus :-The uterus is most common site of

infectionDecidua is common site and

infected firstThe infection usually manifests

between 3rd and 6th day of delivery

Putrid endometritis:-The decidua become infected and

necrosed and slough off.The infection of the deeper

myometrium is prevented by a zone of leukocytic barrier.

The discharge become offensive

Infection spread to distant site may occur when infection is sever by

organism like beta hemolytic streptococci.

SPREAD OF INFECTIONPelvic cellulitis:-

◦Infection of the pelvic peritoneum and levator ani muscles.

Salpingitis:- infection of the fallopian tube and

overies with the formation of tubo ovarian mass

Peritonitis :-Lacalised pelvic abscess

Thrombophelebitis :-Ovarian vein of one side is usually

involvedUterine vein may also involved’Septicemia and pyemia:-These may lead to endocarditis,

pericarditis,Renal abscess, lung abscess,

meningitis or artheritis.

“These are rare these days with advent of potent antibiotic”

CLINICAL FEATURES

Local infection-slight raise in temperature,

generalised malaise and headache.Redness and the swelling of the local

woundPus formation and disruption of

woundUterine infection-Pyrexia of variable degree and

tachycardia.Red, copius and offensive lochia.Subinvoluted, tender and soft

uterus.

Sever infection-Fever with chills and rigorRapid pulseScanty, odorless lochiaInvoluted uterusParemetritis-Sustained rise in temperature (7th to 10th

day)Constant pelvic painTenderness on either side of the

hypogastriumUnilateral, tender mass felt on vaginal

examinationleukocytosis

Pelvic peritonitis:-Pyrexia with increased pulse rateLower abdominal pain and

tendernessCollection of the pus in pouch of

douglas

Generalised peritonitis:-High fever with rapid pulseVomitingAbdominal painTender and distended abdomen

Thrombophelebitis –swinging fever with chills and rigorFeatures of pyemia

Septicemia-High temperature with rigorRapid pulseHeadache, insomnia or mental

confusionPositive blood cultureSign/symptoms of infection in the

lungs, meninges or joint

INVESTIGATIONBacteriological study-SmearCulture and antibiotic sensitivity

of purulent materialHigh vaginal and cervial swabsPeritoneal fluidsBlood culture

Urine :-Routine and microscopic

examinationCulture if infection is suspected

Complete blood count-

Ultrasonography-For diagnosis of pelvic massesPelvic abscessPelvic peritonitisRetained bits of placenta and/ or membrane

Other specific investigation

X – ray Blood for malaria parasite

PREVENTION

AntenatalImprovement of general conditionTreatment of septic cocciAbstinence from sexual intercourse in the

last two monthsCare about personal hygiene – bathing in

dirty water to be avoidedAvoiding contact with people having

infection, such as cold, boils.Avoiding unnecessary vaginal

examinations and douches in the later months.

IntrapartumStaff attending on labor client should be free of

infections.

Full surgical asepsis to be taken while conducting delivery

Women having respiratory tract infection or skin infection should be admitted in single room or separate ward

Membranes should be kept intact as long as possible and vaginal examination should be restricted to minimum

Traumatic vaginal delivery and intrauterine manipulation should be preferably avoided. If required , should be done using fresh (sterile) gloves with liberal use of strong antiseptic solution.

Laceration of the genital tract should be repaired promptly and meticulously with perfect homeostasis

Excessive blood loss during delivery should be replaced promptly by transfusion to improve the general body resistance

Prophylactic antibiotic must be administered in cases of premature rupture of membranes, prolonged labor or following traumatic delivery.

Postpartum Take aseptic precautions while dressing the

perineal wound Restriction of the visitor in the postpartum

ward Mothers to be instructed to use sterile

sanitary pads and to change them frequently

Vulva and perineum to be cleaned with mild antiseptic solution following urination and defecation

Infected mothers and babies are to be isolated

To keep the floor of the in – patient ward dust free by frequent mopping.

TREATMENT The woman should be placed in sterile

room/ward with adequate light and ventilation

Complete rest is to be given in head high position which help in drainage of lochia and localization of infection to the pelvis if there is pelvic peritonitis

Analgesics and sedatives are administered to enforce rest

Treatment cont… Broad spectrum antibiotics are given IV

until antibiotic sensitivity report are available, followed by specific antibiotics.

Stool softeners are administered to keep the keep the bowel open

Anemia to be corrected by blood transfusion

Infected wound of perineum valva and vagina are laid open for drainage, cleaned and dressed with antiseptic preparation.

Surgical treatment The stitches of the perineal wound may have to be removed to facilitatedrainage of pus and relieve pain. After the infection is controlled, secondary sutures may be given later. Infected retained product should be

removed as early as possible under cover of antibiotics . Pelvic abscess should be drained by colpotomy

Abscess above the poupart’s ligaments should be incised and the pus drained.

NURSING PROCESS

URINARY TRACT INFECTION

DEFINITION

It is an infection of the urinary organs such as kidney, ureter, urinary bladder and urethra.

CAUSATIVE ORGANISM E. coliKlebsiellaProteusStaphylococcus aureus

Other causes are:-Recurrence of previous cystitis and

pyelitisInfection contracted for the first time

during pregnancy is due to :-Effect of frequent catheterization either

during labor or in early puerperium to relative retention of urine.

Stasis of urine during early puerperium due to lack of bladder tone and less desire to pass urine.

INCIDENCE It is one of the common cause of

puesperal pyrexia, the incidence being 1- 5 % of all deliveries.

CLINICAL FEATURES

Raised temperature ( pyrexia)Costovertebral angle painSupra pubic discomfortFrequent and often painful

micturationNausea and vomiting

DIAGNOSIS

UTI is confirmed by examination of an uncontaminated midstream clean catch sample for urinalysis and culture and antibiotic sensitivity test.

MANAGEMENT

High fluid intake

Adequate drainage of urine

Appropriate antimicrobial therapy.