Irish Jane B.

Cubillo
III BSN-1


Postpartal Pueperal Infection

Republic of the Philippines
CAVITE STAE UNIVERSITY
Don Severino Delas Alas Campus
Indang, Cavite


COLLEGE OF NURSING





POSTPARTUM COMPLICATIONS




Presented by:
Ariane Rose S. Cedron
Irish Jane B. Cubillo
Roxane Jade K. Dala
III BSN-1
Group 3A



Presented to:
Jane A. Rona RN, MAN




January 29, 2014




In partial Fulfillment of the Requirement in NURS for the Degree Bachelor of
Science in Nursing
VISION
A premier university in historic Cavite
recognized for excellence in the
development of morally upright and
globally competitive individuals.
MISSION
Cavite State University shall provide
excellent, equitable and relevant
educational opportunities in the arts,
science and technology through quality
instruction and relevant research and
development activities. It shall produce
professional, skilled and morally upright
individuals for global competitiveness.

The postpartum period is a time of increased physiologic stress and major psychological
transition. Energy depletion and fatigue of late pregnancy and labor, soft-tissue trauma from
delivery, and blood loss increase the womans vulnerability to complications. Most women
recover from the stresses of pregnancy and childbirth without significant complications.
However, postpartum complications can occur. The potential seriousness of many postpartum
complications; associated pain, procedures and medications; frequent need to be isolated or
separated from the newborn; emotionally disruptive effects of the physiologic malfunction can
interfere with the maternal-newborn bonding process.
Postpartum Puerperal Infection
- Postpartum infections of the genital tract associated with childbirth; usually are the result
of bacteria ascending from the genital tract.
- Often remain localized, but they extend along vascular or lymphatic pathways to produce
extensive pelvic and systemic infections.
- One of the most common causes of morbidity in the postpartum period.
- The course of the illness varies according to:
the size of the bacterial inoculums
virulence of the organism
the pelvic tissues affected
- Fever: principal sign
Etiology
- Idiopathic;
- Risk factors:
Related to general infection risk
Anemia
Nutritional deficiencies
Lack of prenatal care
Obesity
Low socioeconomic status
Sexual intercourse after rupture of membranes

Immunosuppression

Related to labor events
Prolonged labor
Prolonged rupture of membranes
Chorioamionitis
Greater number of vaginal examinations
Hemorrhage

Related to operative risk factors
Cesarean delivery
General anesthesia
Urgency of operation
Breaks in operative techniques
Manual placental removal
Forceps delivery
Episiotomy
Lacerations
- Causative agent:
Anaerobic (not requiring oxygen for growth): gram negative
bacilli- Bacteroides species
Aerobic (requiring oxygen for growth): most common; gram
positive cocci- Streptococcus species
Nursing Assessment
- Focuses on early identification of signs and symptoms;
Monitor progress and physiologic function including uterine
involution
Note needs for comfort and education
Identify emotional reactions and needs

Vital signs
Assess:
Condition of the perineum and uterus
Character of lochia
Condition of extremities and breasts
Status of bladder
Bowel function
Nursing Intervention
- Prompt diagnosis and treatment of the postpartum infection to minimize serious sequelae
and reduce their effects on the clients ability to function are essential.
Antibiotic Therapy
Specimen collection
Wound debridement or cleansing
Analgesic administration and monitoring
Comfort measures for pain relief
Health teaching about the infectious process
Prevention of Infection
Avoid possible sources of infection
Careful hand washing
Standard precautions







Endometritis
- A localized infection of the inner uterine wall
- Begins at the placental site and may spread to
involve the entire endometrium
- Bacteria gain access to the uterus through the
vagina and enter the uterus either at the time of
birth or during the post partal period
- Following vaginal delivery, about 2%-3% develop endometritis
- may occur with any birth, but the infection is usually associated with chorioamnionitis
and cesarean birth
Clinical Manifestations
- benign temperature elevation (first post partal day)
- increase in white blood cells
- increase in oral temperature to more than 38 C for two consecutive 24-hour periods
- chills
- loss of appetite
- general malaise
- uterus not well contracted and painful to touch
- lochia is dark brown and has foul odor
- if the infection is accompanied by high fever, lochia may be scant or absent
- if the infection is caused by hemolytic Streptococcus, the lochia usually is odorless
Diagnostic Procedures
- Ultrasound: to confirm the presence of placental fragments that are a possible cause of
the infection
- Lochia culture
- Hysterosalpingogram



Nursing Management
- Emotional support
- Fowlers position or walking: promote lochial drainage
- Hand washing technique
- Monitor:
progress of uterine involution
fundal height and firmness
tenderness
characteristics of lochia
- Increased fluid intake(3L-4L/day)
- Well-balanced diet
- Advise mother to avoid breastfeeding if necessary
- Antibiotics:
Clindamycin (Cleocin)
Metronidazole
Gentamicin
Aztreonam
Aminoglycoside







Wound Infection
- Also known as infection of the perineum
- If a woman has a suture line on her perineum from an
episiotomy or a laceration repair, a portal of entry exists
for bacterial invasion
- Usually remains localized
Clinical Manifestations
- Pain
- Heat
- Feeling of pressure
- May or may not have elevated temperature
- Inflammation on the suture line
- Suture line may be open with presence of purulent discharge
Diagnostic Procedures
- Culture of the discharge using a sterile cotton-tipped applicator
Nursing Intervention
- Nurse-midwife may remove the perineal suture to allow drainage
- Packing, such as iodoform gauze may be placed in the open lesion
- Systemic or topical antibiotics
- Analgesics to alleviate discomfort
- Sitz bath
- Moist warm compress
- Hubbard tank treatment
- Remind patient to change perineal pad frequently
- Wipe front to back after bowel movement


Urinary Tract Infection
- A woman who is catheterized at the time of childbirth or
during the postpartal period is prone to development of a
urinary tract infection, because bacteria may be introduced
into the bladder at the time of catheterization.
- Physiologic urinary stasis, dilatation of the ureters and
vesicoureteral reflux that occur during pregnancy persist for
several months after delivery
- Occurs 5% of postpartum client and are usually caused by
coliform bacteria (E. coli, enterococci, Klebsiella
pneumonia)
- Postpartum urinary retention and incomplete emptying of the bladder are common
because of increased bladder capacity, decreased tone and decreased perception of the
urge to void caused by perineal trauma.
- If client is unable to empty the bladder fully, the remaining urine is a culture medium for
the bacterial growth, often leading to cystitis (inflammation of the bladder) or
pyelonephritis (inflammation of the renal pelvis).
Risk factors
- Cesarean birth
- Use of forceps or vacuum extraction
- Epidural anesthesia
- And catheterization during labor
Clinical Manifestations
- Burning on urination
- Blood in the urine (hematuria)
- Feeling of frequency in urinating
- Sharp pain on urinating
- Low grade fever

- Lower abdominal pain
Diagnostic Procedures
- Physical examination
- Urinalysis: Obtain a clean-catch urine specimen; examine the following:
Leukocytosis
Red blood cells
Bacteria
Nursing Interventions
- Encourage a woman:
to drink large amounts of fluid
to perform proper perineal care
to use of cotton underclothing
to void frequently
to void before and after the intercourse
- Broad -spectrum antibiotic
Amoxicillin
Ampicillin
- Oral analgesic: to reduce the pain of urination
Acetaminophen (Tylenol)



References: Maternal and Child Nursing by Adele Pillitteri 6
th
Ed. (pg. 682~690)
Maternity Nursing family, Newborn and Womens Health Care 8
th
Ed.
(pg.1028~1041)