Puerperal Sepsis
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It is the infection of the uterus and surrounding tissues within 6 weeks postpartum manifesting as postpartum metritis, postpartum endometritis parametritis, peritonitis or septicaemia.
Clinical presentation
- Fever
- Foul smelling lochia
- Lower abdominal pain or generalized abdominal pain and tenderness
- Delayed involution
Investigations
- Full blood picture and Cross Matching
- Check LFT, RFT, Electrolytes
- Blood culture in case of suspected septicaemia
- Abdominal pelvic ultrasound
Management of Puerperal sepsis at Dispensary and Health Center
A: Establish IV line and give compound sodium lactate/0.9% sodium chloride 2l then continue as required
AND
B: Amoxicillin + Clavulanic acid (FDC) (PO) 625 12hourly for 5days
AND
A: metronidazole (PO) 400mg hourly for 5days
AND
A: gentamycin (IV) 80mg 12hourly for 24-48hours
Referral: resuscitate and refer immediately to hospital for further investigations and management.
Management of puerperal sepsis at the hospital
- Blood transfusion in anaemic
- Plan interventions (eg laparotomy, uterine evacuation etc) appropriately
- Continue with the above antibiotic for 5-7 days
- Adjust drugs depending on the Culture and susceptibility results or if not available and there is no improvement after 3 days of treatment with above antibiotics switch to:
B: metronidazole (IV) 500mg 8hourly for 5-7days
AND
D: ceftriaxone + sulbactam (FDC) (IV) 1.5g 12hourly for 5-7 days
OR
S: piperacillin + tazobactam (FDC) (IV) 4.5g 12hourly for 5-7days
Prevent Puerperal infections by:
Observation of aseptic technique when performing all obstetric procedures including Pelvic examinations during labour. Administration of prophylactic antibiotics within 1hour before performing a caesarean section or manual removal of Placenta.
C: amoxycillin + clavulanic acid (FDC)(IV) 1.2g stat
OR
D: ceftriaxone + sulbactam (FDC) (IV) 1.5g stat
AND
B: metronidazole (IV) 500mg stat