Chapter: Obstetric and Gynecological Nursing : Abnormal Puerperium

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Puerperal Sepsis

Infection of the genital tract that occurs at any time between therupture of membranes in labour and 42 day following delivery or abortion with the following symptoms.

Puerperal Sepsis

 

Infection of the genital tract that occurs at any time between therupture of membranes in labour and 42 day following delivery or abortion with the following symptoms.

 

·        Pelvic pain

 

·        Fever 38.50C or more

 

·        Abnormal smell, foul dour of vaginal discharge

 

·        Delay in the rate of reduction of the size of the uterus.(sub involution)

 

Cause

 

·        Endogenous bacteria

 

·        Exogenous bacteria

 

Risk factors for puerperal sepsis

 

·        Poor hygiene

 

·        Poor aseptic technique

 

·        Manipulations in birth canal

 

·        Presence of dead tissue in the birth canal due to IUFD

 

·        Retained fragments of placenta or membranes shedding of dead tissue from vaginal wall following obstructed labour.

 

·        Insertion of unsterile hand, instrument or packing / traditional practices should also be examined/

 

·        Pre existing anemia and malnutrition

 

·        Prolonged of obstructed labour

 

·        Prolonged rupture of membrane

 

·        Frequent vaginal examinations

 

·        Caeserean section and other operative deliveries

 

·        Unrepaired vaginal or cervical lacerations

 

·        Preexisting sexually transmitted disease

 

·        Post partum hemorrhage

 

·        Not being immunized against tetanus diabetes

 

Site of infection

 

i.                     Placental site

 

ii.                     Perineum

 

iii.                     Vagina

 

iv.                     Cervix

 

v.                     Uterus

 

Women are vulnerable to infection in the proportion because the placental site is large, warm, dark moist, rich to grow very quickly. During delivery traumatized tissue of tear in the vagina or perineal area is susceptible to infection.

 

Managing Puerperal sepsis

 

1. Isolation and Barrier nursing of the woman

Nurse the woman in a separate room, use gloves only when attending her keep one set of equipment, dishes and other utensils for the use of this woman, wash hands carefully before & after attending this woman.

2. Administration of high doses of antibiotics / Broad spectrum/

3. Give plenty of fluids:- the aim of this is to correct orprevent dehydration and help to lower the fever. In severe cases it is necessary to give IV fluids at first.

4. Ruling out Retained placental fragments:- suspect thisif the uterus is soft and bulky, if lochia are excessive and contain blood clots, it can be a sign of puerperal sepsis. The woman should be referred to a facility that has the equipment and health care personnel trained to perform acurettage.

5. Providing skilled nursing care:- Careful attention to thecomfort of the woman. It is important for the woman to rest, monitor uterine size, measure in take and out pout, keep accurate recurs, prevent spread of infection and cross infection .Accurate observation, recording and reporting.

 

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