Beruflich Dokumente
Kultur Dokumente
Dr.Zainab Shamsuddin
Hospital Kuala Lumpur
DEFINITIONS
Puerperal Pyrexia
Temperature of 38 C on any occasion in the first 14
days after delivery or miscarriage
Causes
DEFINITIONS-cont.
Puerperal sepsis refers to infection of the genital tract after
delivery. The term is synonymous with the older
expressions of puerperal fever and childbed fever.
(Although infection of the abdominal wound following
Caesarean section is more correctly termed a wound
infection, such cases are commonly regarded as variants of
puerperal sepsis).
PATHOGENESIS
METHODS OF SPREAD
Puerperal sepsis is generally an ascending infection,
proceeding along the lumen of the genital tract. The
placental site is almost always involved and the
extraplacental decidua also offers very little resistance to
the spread of infection, being at this time very thin,
traumatized and infiltrated with blood.
Translumenal spread may extend beyond the uterus, into
and through the Fallopian tube, and thence to the pelvic
peritoneum where abscess formation may occur. A
generalized peritonitis may ensue. The full thickness of
the uterine wall, from decidua to peritoneum, is almost
always involved.
PERSIDANGAN KEMATIAN IBU KEBANGSAAN ,PULAU PINANG 30-31 OKT.2007
Early
pregnancy
(n)
Puerperal
(n)
After
surgical
procedure
(n)
Before or
during
labour
(n)
Total
(n)
Rate per
million
maternities
1985 87
4.0
1988 90
17
7.2
1991 93
15
6.5
1994 96
2b
11
17
7.3
1997 99
2+2
Late
18
8.4
Total no. of
maternal
deaths
Total death
from
Puerperal
sepsis
Mode of
delivery
Accoucher
1997
158
1.9
2 SVD
DR 1
1998
182
4.9
7 SVD
DR 3
1999
168
1.2
2 SVD
2000
146
4.1
5 SVD
TOTAL
654
20
3.1
16 SVD
DR 1
SEVERITY OF INFECTION
AND DEGREE OF SPREAD
Pathogen-related factors
a) The specific microorganism involved
Host-related factors
a) General health
b) Immune status
c) Risk Factors related to the pregnancy
i. Route of delivery
ii. Duration of labour
iii.Invasive examinations in labour
iv.Rupture of the membranes and preterm labour
MICROBIOLOGY
The most common organism responsible for serious and lifethreatening obstetric infections is the beta-haemolytic Streptococcus
pyogenes (Lancefield Group A). The Lancefield Groups C and G
streptococcus may also cause serious clinical syndromes but are
less common.
CLINICAL FEATURES
1. Head, neck and spine
2. Breasts
3. Heart and lungs
4. Abdomen
The abdomen must be generally examined, noting the presence of
free fluid, enlargement of liver and spleen, and any abnormal
masses. Particular note must be taken of uterine size and
tenderness, renal angle tenderness and the presence or absence
of signs of peritonitis. The presence or absence of bowel sounds
should be recorded.
5.Pelvis
A pelvic examination must be performed in all cases. The lochia
should be checked for colour, consistency and unpleasant odour.
The external genitalia must be inspected, and infected lacerations
sought in the lower tract.
Bimanual palpation of the uterus and parametrial tissues must be
done. The size of the uterus and the degree of tenderness should
be noted. The pouch of Douglas must be carefully examined as
this is a common site for abscess formation.
6. Limbs
MANAGEMENT
-is complex, and best undertaken in an ICU.
-aspects that will require therapy include :
a) Fluid balance
b) Respiratory support
c) Circulatory support
d) Renal failure
e) Infection control
f) Corticosteroids
PERSIDANGAN KEMATIAN IBU KEBANGSAAN ,PULAU PINANG 30-31 OKT.2007
c) Local therapy
d) Antibiotics
Surgery
CASE ILLUSTRATIONS
FROM CEMD
a) Basic principles
b) The case of emergency Caesarean section
i. Technical aspects of the operation
RECOMMENDATIONS
The onset of life-threatening sepsis at any stage of
pregnancy can be insidious and all doctors and
midwives must be aware of the symptoms and signs and
be prepared to institute immediate treatment to avoid
serious consequences.
When
THANK YOU