Saturday, December 29, 2018

Puerperal Sepsis Treatment | Puerperal Sepsis Complications

What is Puerperal Sepsis?
Puerperal sepsis, also known as child-bed fever and puerperal fever is any bacterial infection of the female genital tract which occurs at any time between the onset of rupture of membranes or labor, and the 42 days of postpartum. It is usually more than 24 hours after delivery before the symptoms and sign appear. However, the woman has had prolonged rupture of membranes or prolonged labor without prophylactic antibiotic, then the disease may become evident earlier. 
Puerperal sepsis treatment guidelines
Fig: Puerperal sepsis treatment guidelines
Necessary Tests for Puerperal Sepsis Diagnosis:
Some important investigation must be done to diagnose puerperal sepsis, those are listed in the below:

  • Physical examination,
  • Ultrasound scan (USS) of the pelvis,
  • X-ray chest/abdomen (to detect perforations),
  • Complete blood count (CBC),
  • Urine full report(UFR),
  • Wound swab ( perineal or abdominal),
  • Blood culture, in the presence of chills or evidence of severe infection.

Puerperal Sepsis Treatment Guidelines:
If the puerperal infection is diagnosed, treatment must be started as soon as possible. The below are the treatments for puerperal sepsis:

  1. Start of intravenous broad-spectrum antibiotics without delay in suspicion of severe sepsis, with or without septic shock.
  2. If genital tract sepsis is suspected, start early treatment with a combination of high-dose broad-spectrum intravenous antibiotics.
  3. Start antibiotics after taking samples for microbiology. Amoxycillin- clavulanic acid – 1.2 gms. Intravenous 8 hourly or 625mg. oral 8 hourly/twice a day or Ampicillin 500mg. intravenous 6 hourly.
  4. Or start penicillin with gentamicin and metronidazole provides the broadest coverage.
  5. A combination of piperacillin/tazobactam or a carbapenem plus clindamycin provides one of the broadest ranges of treatment for severe sepsis.
  6. MRSA may be resistant to clindamycin, a glycopeptide such as vancomycin or teicoplanin may be added until sensitivity is known.
  7. Breastfeeding limits the use of some antimicrobials; hence the advice of a consultant microbiologist should be sought at an early stage.

Complications of Puerperal Sepsis:
Complications are not so common but they can develop if diagnosis and treatment are not started quickly. Possible complications include:

  • Abscesses or pockets of pus,
  • Peritonitis,
  • Pelvic thrombophlebitis,
  • Pulmonary embolism,
  • Sepsis or septic shock.

More questions related to this article?
  1. What does puerperal sepsis mean?
  2. What are the tests to diagnose puerperal sepsis?
  3. What are the necessary tests to diagnose puerperal sepsis?
  4. Mention some guidelines for puerperal sepsis.
  5. What are the guidelines of puerperal sepsis?
  6. How do you treat the postpartum infection?
  7. What is the treatment for uterus infection?
  8. Mention some common complications of puerperal sepsis.
  9. What are the major complications of puerperal sepsis?