Puerperal Pyrexia Flashcards
What is puerperal pyrexia?
Presence of fever (38 or above) in a woman within 6 weeks of her having given birth
What is the importance of puerperal sepsis?
It is a major cause of maternal mortality worldwide
How many woman die annually per year of puerperal sepsis?
75,000
Where do most of the deaths from puerperal sepsis occur?
In low income countries
What is the incidence of death from genital tract sepsis in the UK?
0.29 / 100,000
What are the causes of puerperal pyrexia/
- Urinary tract infection
- Genital tract infection
- Mastitis
- Post-op infection following C-section
- DVT
- Other infections
What bacteria cause 95% of post-partum UTIs?
- E. Coli
- Proteus
- Klebsiella
What can cause genital tract infection in the postpartum period?
- E. Coli
- Other anaerobes
- Group A streptococcus
- Staphylococcus spp.
What bacteria usually causes mastitis?
Staphylococcus spp.
What is the risk of infection following LSCS in the UK?
8%
What other infections can cause puerperal sepsis?
Infections common to all, e.g. viral infection or chest infection
Why are the symptoms important in puerperal sepsis?
Because they may help localise where the source of infection is
What are the symptoms of UTI
- Frequency
- Dysuria
- Haematuria
When may a UTI present with rigors?
If there is pyelonephritis
What are the symptoms of genital tract infection?
- Tender, bulky uterus
- Prolonged bleeding/pink or discoloured lochia
- Painful, inflamed perineum
What are the symptoms of mastitis?
- Flu-like symptoms
- Painful, hard, red breast with possible abscess
- Nipple trauma and cellulitis
What are the symptoms of post-LCSC infection?
- Painful, red suture line
- Deep tenderness on palpation
- Lochia pink/discoloured
What are the symptoms of DVT?
Painful and swollen calf
What do you need to determine when taking a history from someone with suspected puerperal sepsis?
- When the membranes ruptured
- Length of labour
- Instrumentation used
- Sutures required
- If placenta was complete
- If any bleeding during or after delivery
What investigations should be done in suspected puerperal sepsis?
- High vaginal swab
- Urine culture and microscopy
- Other swabs as necessary, e.g. wound swabs, throat swabs
- FBC
- Blood cultures x2
- Ultrasound scan
When might ultrasound scan be required in suspected puerperal sepsis?
To assist in diagnosis of retained products of conception
What general measures should be taken in the management of puerperal sepsis?
Rest and adequate fluid intake are required, particularly for mothers who are breastfeeding
What may be helpful for pain relief from perineal wounds or mastitis?
Ice packs
What is recommended when severe sepsis is suspected?
IV administration of broad-spectrum antibiotics within 1 hour
What should antibiotics be commenced after when there is a suspicion of sepsis?
Taking specimens
Should you wait until the results of specimens are available until giving antibiotics in suspected sepsis?
No
What antibiotic regime is recommended in sepsis?
Combination of piperacillin/tazobactam, or a carbapenum + clindamycin
What is the advantage of the combination of antibiotics given in sepsis?
Provides broadest ranges of treatment
When should the advice of a consultant microbiologist be sought in puerperal sepsis?
At an early stage
Why should the advice of a microbiologist be sought at an early stage in puerperal sepsis?
Breastfeeding limits the use of some anti-microbials
When is IV immunoglobulin recommended in puerperal sepsis?
In severe invasive streptococcal or staphylococcal infection, if other therapies have failed
What analgesia should be avoided in cases of puerperal sepsis?
NSAIDs
Why should NSAIDs be avoided in cases of puerperal sepsis?
As they inhibit the ability of polymorphs to fight GAS infection
What do the possible complications of puerperal sepsis depend on?
The site
What complications are common to all sites of puerperal sepsis?
- Septicaemia
- Pulmonary embolism
- Disseminated intravascular coagulation
- Pneumonia
What are the specific complications of puerperal genital tract sepsis?
- Abscess formation
- Adhesions
- Peritonitis
- Haemorrhage
- Subsequent infertility
What are the specific complications of puerperal urinary tract sepsis?
- Pyelonephritis
- Renal scarring
What are the specific complications of puerperal mastitis?
Formation of breast abscess
What measures can be taken to avoid puerperal sepsis?
- Any GAS infection identified during pregnancy should be treated aggressively
- Catheterisation should be avoided where possible
- Perineal wounds should be cleaned and sutured as soon as possible after delivery
- All blood losses and the completeness of the placenta should be recorded at deliveries
