Puerperal Infection

WHAT IS PUERPERAL INFECTION?

Puerperium is the period following childbirth during which the body tissues, especially the pelvic organs revert back to the pre-pregnant state both anatomically and physiologically, in about 6 weeks. Infection of the birth canal (consisting of vagina, vulva, perineum, cervix, uterus, peritoneum) within the first few days of puerperium is known as puerperal infection.

SEX OR AGE MOST AFFECTED

Women who have just delivered.

SIGNS & SYMPTOMS

  • Unexplained fever and chills for 2 or more days after the first postpartum day
  • Headache, body aches.
  • Loss of appetite.
  • Rapid heartbeat.
  • Soft, large, tender uterus.
  • Vaginal discharge with an unpleasant odor.
  • Abdominal pain.

CAUSES

Infection by bacteria normally found in a healthy vagina. These bacteria can infect the uterus, vagina, adjacent tissues and kidney, in conjunction with the risk factors as listed below.

RISK INCREASES WITH

  • Instrumentation such as forceps during labor.
  • Anemia, either pre-existing or from loss of blood during delivery.
  • Toxemia during pregnancy.
  • A delay of more than 24 hours between rupture of the placental membranes and delivery
  • Prolonged labor.
  • Traumatic delivery.
  • Repeated vaginal examinations with unsterile equipment during labor.
  • Retained fragments of placenta in the uterus.
  • Excessive bleeding after delivery.

HOW TO PREVENT

  • Vaginal examinations should be kept to a minimum and should be carried out using sterile equipment.
  • Avoid intercourse in the last two months of pregnancy.
  • Notify your doctor as soon as placental membranes rupture (your "water breaks").
  • Change sanitary pads regularly after delivery,
  • Wash the perineal area often during the first week after delivery especially after urination and passing stools.

DIAGNOSTIC MEASURES

  • History and examination by a doctor.
  • Laboratory blood studies and culture of the blood and vaginal discharge.

POSSIBLE COMPLICATIONS

  • Deep-vein blood clot in the pelvis.
  • Sepsis – spread of infection to the body via the blood stream
  • Shock.

PROBABLE OUTCOME

Usually curable in 7 to 10 days with intensive treatment. Without treatment, complications can be fatal.

TREATMENT

GENERAL MEASURES

  • To relieve pain, place a heating pad or hot-water bottle on the abdomen or back.
  • Take frequent hot baths to relax muscles and relieve pain.
  • Use sanitary pads rather than tampons for the vaginal discharge.
  • If you plan to breast-feed, use a breast pump to express milk until the infection heals.

MEDICATION

Your doctor may prescribe:

  • Antibiotics in high doses--intravenously, if necessary.
  • Pain killers to reduce pain.
  • Anticoagulants to prevent blood-clot formation.

ACTIVITY

  • Rest in bed, except to use the bathroom, until fever and other signs of infection subside. You will probably be more comfortable if you lie on your left side.
  • Abstain from sexual relations for a week after signs of infection subside.

DIET

Drink lots of fluids to prevent dehydration from high fever. Vitamin and mineral supplements should not be necessary unless you are anemic.

CALL YOUR DOCTOR, IF

After delivery:

  • You have symptoms of a puerperal infection
  • You develop a skin rash.
  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
  • Symptoms of infection recur after treatment.