CLINICAL PRESENTAION

ON
PUERPERAL SEPSIS

SUBMITEDV TO SUBMITED BY
MRS SHAIAHNAZ MADAM N. TANMAI
PRINCIPAL & HOD OF OBG DEPT MSC NURSING 1 ST YEAR
 STUDENT PROFILE

NAME OF THE STUDENT : N. TANMAI

NAME OF THE TOPIC : PUERPERAL SEPSIS

SUBJECT : OBSTETRICAL AND GYNECOLOGICAL NURSING

GROUP : MSC NURSING II

ND
YEARS

TEACHING AND LEARNING ACTIVITY : LECTURE AND DISCUSSION

AV AIDS : TRANSPERENCY, FLIPCHART FLASH CARDS , CHART AND PPT

TIME : 11 AM

DATE : 17 -04 -18

PLACE : FEMALE WARD

SUPERVISED BY : MRS KARUNA MADAM

GENERAL OBJECTIVE
By the end of my teachig group will be able to gain knowledge regarding prolonged labour

SPECIFICOBJECTIVE
At the end of my teaching group will be able to

At the end of the learning session, the student

should be able to:
1. Define puerperal sepsis
2. State the causes of puerperal sepsis
3. Explain the clinical manifestation of puerperal sepsis
4. Describe the management of puepueral sepsis
 Objective Content Teaching Learning Av aids Evaluation
activity activity
2min Explain definition Puerperal infection is an infection of the Introduces the Listens and Black board
of puerperal sepsis reproductive tract occurring within 28 topic make a note
days following childbirth or abortion. It
is one of the major causes of maternal
death (ranking second behind postpartal
hemorrhage) and includes localized
infectious processes as well as more
progressive processes that may result in
endometritis/metritis (inflammation of
endometrium), peritonitis, or
parametritis/pelvic cellulitis (infection of
connective tissue of broad ligament and
possibly connective tissue of all pelvic
structures). (This plan of care is an
adjunct to the regular postpartal plans o
 The pathogenicity of the vaginal flora
Explain causes of may be influenced by certain factors :-
2min puerperal sepsis 1) The cervicovaginal mucous membrane
is damaged even in normal delivery .
2) The uterine surface too , especially the
placental site , is converted into an open
wound by the cleavage of the decidua
which takes place during the third stage
of labor , and
3) The blood clots present at the placental
site are excellent media for the growth of
the bacteria .
 Antepartum risk factors :-
1) Malnutrition and anemia
2) Preterm labour
3) Premature rupture of the membranes
4) Immunocompromised (HIV)
5) Prolonged ruptured of membrane more
than 18 hours ,
6) Diabetes
 Intrapartum risk factors :-
1) Repeated vaginal examinations .
2) Dehydration and ketoacidosis during
labour
3) Traumatic vaginal delivery
4) Haemorrhage --antepatum or
postpartum ,
5) Retained bits of placental tissue or
membranes
6) Prolonged labour
 7) Obstructed labour
8) Cesarean delivery
Predisposing factors of my mother is
Malnutrition and anemia
Premature rupture of the membranes
To explain signs
2min and symptoms of
puerperal sepsis
Malaise, lethargy Exhaustion and/or
ongoing fatigue (prolonged labor,
multiple postpartal stressors)

Tachycardia of varying severity

Diarrhea may be present. Bowel sounds

may be absent if paralytic ileus occur

CLINICAL FEATURES :-
 Local infection Explain its by Listen and TRANSPERENC
 Uterine infection showing make notes Y
 Spreading infection transparency
 Local infection ( Wound infection ) :-
1) There is slight rise of temperature ,
generalized malaise or headache ,
2) The local wound becomes red and
swollen ,
3) Pus may form which leads to
disruption of the wound , there is rise of
temperature with chills and rigor .
 Uterine infection :-
MILD :-
 1) There is rise of temperature (> 100.4 ₒ
F ) and pulse rate (>90) ,
2) Lochial discharge becomes offensive
and copious ,
3) The uterus is subinvoluted and tender .
SEVERE :-
2min 1) The onset is acute with high rise of
temperature , often with chills and rigor .
2) Pulse rate is rapid , out of proportion
to temperature ,
3) Often there is breathlessness , coughs ,
abdominal pain and dysuria ,
4) Lochia may be scanty and odourless ,
Explain signs and 5) Uterus may be subinvoluted , tender
symptoms of and softer .
prolonged labour 6) There may be associated wound
infection ( perineum , vagina or the
cervix ) .
 Spreading infection ( Extra uterine
spread ) :- Discussion Actively
It is evident by presence of pelvic interacts in Black
tenderness ( pelvic peritonitis ) , the Board
tenderness on the fornix (parametritis ) , discussion
2min bulging fluctuant mass in the pouch of
Doulas ( pelvic abscess ) .
 Parametritis :- The onset is usually
about 7 to 10 th day of puerperium .
slight rise of temperature
Lochial discharge becomes offensive and
copious ,
Fundal height is 15 cm
 The uterus is subinvoluted and tender

Describe History :-
investigations lecture Listens and
2min Clinical examination notes key
points Black
Investigation include :- board
BLOOD for HB, TC and DC , Thick blood
film for Malaria Parasites .
 Pelvic Ultrasound to detect any retained
bits of conception within the uterus , to
locate any abscess with the pelvis , and
collecting samples from the pelvis .
 CT scan and MRI .
 X –ray chest should be taken in cases
with suspected pulmonary Koch’s lesion
 Blood urea and electrolytes

Isolation of the patient is preferred

specially when haemolytic streptococcus is
Explain medical
obtained on culture .
management
 Adequate fluid and calorie is supplied if
needed by intravenous infusion.
 Anaemia is corrected by oral iron and if
needed by blood transfusion .
 Pain is relieved by adequate analgesia .
 An indwelling catheter is used to relieve
any urine retention due to pelvic abscess. It
also help to record urinary output,
 A chart is maintained by recording
pulse, respiration, temperature, lochial
 discharge, and fluid intake and output. Explains Listens and
 Antibiotics :- Depend on the culture and principle by notes key
sensitivity report pending the report, showing chart points Flip
3min  Inj. Gentamicine (2mg / kg IV loading
Chart
dose, followed by 1.5mg / kg IV every 8
hours ) and
 Inj. clindamycin ( 900mg IV every 8
hours) should be started .
 Inj. Metronidazole 0.5 g.IV is given at 8
hours interval tocontrol the anaerobic
group .
 The treatment is continued until the
infection is controlled for atleast 7 – 10
days.
 In case of severe sepsis :-
 A combination of either piperacillin –
tazobactam or carbapenem puls
clindamycin has broadest range of
antimicrobial coverage .
Isolation of the patient
Adequate fluid and calorie is supplied
Anaemia is corrected by oral iron
Pain is relieved by adequate analgesia
PCM 1 Tab TDS
A chart is maintained by recording pulse,
respiration, temperature, lochial discharge,
and fluid intake and outpu
SURGICAL TREATMENT : there is little
role of major surgery in the treatment of
puerperal sepsis.
 Perineal wound – the stitches of the
perineal wound may have to be removed to
 facilitate drainage of pus and relieve pain.
The wound is to be cleaned with sitz bath
several times a day and is dressed with an
antiseptic ointment or powder. After the
infection is controlled, secondary suture
may be given.
 Retained uterine products with a Black
diameter of 3 cm or less may be Board
disregarded and left alone. Otherwise Discuss the
surgical evacuation after antibiotic purposes
coverage for 24 hours should be done to
2min
avoid the risk of septicemia. Cases with
septic pelvic thrombophlebitis are treated
with IV heparin for for 7- 10 days.
 Pelvic abscess should be drained by
colostomy under theultrasound guidance.
 Wound dehiscence :-
Dehiscence of episiotomy or abdominal
wound following cesarean sectionis
maintained by scrubbing the wound twice
daily, debridment of all necrotic tissue and
then closing the wound with secondary
suture. Appropriate antimicrobials are used
following culture and sensitivity .
 Laparotomy has got limited indications .
 Maintenance of electrolytic balance by
intravenous fluid along with appropriated Flash cards
antibiotic therapy usually controls the
peritonitis . However, in unresponsive
peritonitis, lapatomy is indicated.
 If no palpable pathology is found,
drainage of pus may be effective. Lecture Observes
  Hysterectomy:- method the chart
5min It is indicated in case with rupture or and make
perforation, having multiple abscesses, notes
gangrenous uterus or gas gangrene
infection . Ruptured tubo – ovarian abscess
should be removed .

NURSING MANAGEMENT :-
Assessment :-
 Elevation in temperature to 100.4⁰ F or
above with chills
 Foul smelling lochia
 Abdominal tenderness and pelvic pain
 Pain and burning sensation during
micturation
 Tachycardia
 Increased white blood cells (WBCs )
 Presence of predisposing factors
 Traumatic birth
 Prolonged difficult labour , Prolonged
ruptured of membranes\
 Excessive vaginal discharge
 Anemia
 Retained placentral fragment
 Hemorrhage
 Mother is dehydrated , frustrated due to
extreme fatigue .
 Describe nursing NURSING MANAGEMENT :-
management Assessment :-
 Elevation in temperature to 100.4⁰ F or
above with chills
 Foul smelling lochia Flash cards
 Abdominal tenderness and pelvic pain
 Pain and burning sensation during
micturation
 Tachycardia
2min  Increased white blood cells (WBCs )
 Presence of predisposing factors Discussion Actively
 Traumatic birth
take part in
 Prolonged difficult labour , Prolonged
discussion
ruptured of membranes\
 Excessive vaginal discharge
 Anemia
 Retained placentral fragment
 Hemorrhage
 Mother is dehydrated , frustrated due to
extreme fatigue .

Discussion
 Flash cards

Actively
2min take part in
discussion discussion
method
 Flash cards

2min Lecture Actively

discussion take part in
method discussion
cum

Describe the Actively

roles of supervisor take part in
in micro teaching discussion
 discussion
method

chart

5min

Actively
 discussion take part in
method discussion

2min Back board

 Actively
take part in
discussion
discussion

5min
2min

ppt

lecture listen and

method make
notes
Summary
`
BIBLIOGRAPHY

1. NIMA BHASKER “ nursing education” emessess publications

second edition,(2015) banglore pg no 163—168
2. SHABEER P BASHER NURSING education , ,emmess publications
secondc edition