Puerperal Sepsis

exp date isn't null, but text field is

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