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Managing Complications in Postpartum Period: Puerperal Sepsis

Managing Complications in Postpartum Period: Puerperal Sepsis. Learning Objectives. B y t he end o f t h i s s e ss i on, t he l ea r n e r s w il l be ab l e t o : D e f i ne m a t e r na l / pu e r pe r al seps i s E nu m e r a t e t he r i s k f ac t o r s f or m a t e r nal seps i s

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Managing Complications in Postpartum Period: Puerperal Sepsis

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  1. Managing Complications in Postpartum Period: Puerperal Sepsis

  2. Learning Objectives Bytheendof thissession, thelearnerswill beable to: • Definematernal/puerperal sepsis • Enumeratetherisk factorsfor maternalsepsis • Explainways toprevent sepsis • Describethecauses, symptoms,signsandmanagement ofsepsis • Listthe indicationsfor antibioticsinmother • DiscusstheGoI’srecommendationof broadspectrumantibiotics

  3. Puerperal Sepsis is a Leading Cause of Maternal Death in Postpartum Period • Puerperal sepsis can be prevented and managed by: • 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

  4. Diagnosis Maternal sepsis: Maternal sepsis in general also called Puerperal Sepsis is an infection of the genital tract at any time between the onset of rupture of membranes or labour and the 42nd day following delivery or abortion in which any two or more of the following signs and symptoms are present: • Fever of >100.5 Fahrenheit (>38ºC) • Abnormal, Foul smelling vaginal discharge • Lower abdominal pain • Subinvoluted uterus which is tender

  5. Risk Factors Related to delivery • Failure to follow Infection prevention practices • Poor monitoring of mother during and after labour • Frequent vaginal examinations • PROM >18 hrs • Prolonged/obstructed labour >24 hrs • C-section/ Instrumental delivery • Manipulations high in the birth canal • Dead tissue in the birth canal • Unrepaired vaginal/cervical lacerations • PPH Client-related (Maternal) • Pre-existing STIs/RTIs • Not immunized against tetanus • Pre-existing diabetes • Poor patient hygiene • Pre-existing anaemia and malnutrition

  6. Prevention of Maternal Infection Puerperal sepsis is to a great extent preventable

  7. Principles of Management of Puerperal Sepsis Measure Vital Signs Patient is non-toxic i.e. low grade fever and pulse not rapid (between 90-100/min) Patient is toxic i.e. high grade fever and rapid pulse (>100/min) • 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 • Start IV fluids • Start IV antibiotics • Rule out presence of retained bits of placenta Refer to FRU If vitals improving, then complete course of antibiotics for 5 days If vitals not improving, refer to FRU

  8. Recommended Antibiotic to Mother If mother is well enough to take oral medicine, administer drugs orally only • Very Sick Mother • Not very Sick Mother Ampicillin 1 gm - 6 hourly oral Metronidazole 400mg - 8 hourly oral Gentamycin 80 mg, BD Intra Muscularly • Ampicillin 1 gm - 6hrly Intravenous • Metronidazole 500mg –IV 8 hourly • Gentamycin 80 mg, BD Intra Muscularly

  9. Key messages • Puerperal sepsis isoneoftheleadingcausesof maternal deaths • Puerperal sepsis is to a great extent preventable • Antibioticsshouldbegiven tothewomanonly iftheyareindicated • Atperiphery,ANMshouldidentifythe indicationsfor antibioticsandgivefirstdosebefore referral

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