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Puerperal Sepsis : Causes, Symptoms, and Treatment

5 min read

Puerperal Sepsis Puerperal sepsis or postpartum infection refers to the condition of developing bacterial infections in women after childbirth or during breastfeeding. Whether the delivery is cesarean or vaginal, if a woman has sustained any trauma she runs a risk of developing puerperal sepsis. Use of unclean medical instruments on the private parts and touching the mother with unsanitized hands are major causes behind the infection. The unhygienic environment in a health facility usually induces a fever greater than 38.0 °C (100.4 °F) accompanied by chills, lower abdominal pain and vaginal discharge that could be foul-smelling.

  • What Are The Causes Of Puerperal Sepsis?
  • What Are The Symptoms Of A Puerperal Infection?
  • How Is Postpartum Infection Diagnosed?
  • What Are The Complications Of Postpartum Infections?
  • What Are The Risk Factors Of Developing Postpartum Infections?
  • How Can I Avoid Getting Puerperal Infections?

What Are The Causes Of Puerperal Sepsis?

Puerperal Sepsis encompasses a wide range of postpartum infections, mainly caused by bacteria. The most common bacteria known to cause the infections include chlamydia, clostridium welchii, clostridium tetani, E. coli, gonococci, streptococci, and staphylococci. They can enter the body during labor pelvic examinations if the health professional is untrained and careless. Prolonged labor also increases the chance of infection. Most commonly, the infection develops in the raw interior surface of the uterus after the detachment of the placenta, that is after the delivery. Un-sterilized surgical instruments during a C-section can also cause postpartum infections. Any kind of laceration in the genital tract can cause the disease. The extent of the affliction depends on the type of microorganism, the resistance ability of the infected tissues (or the lack of it), and the overall general health of the new mother. Besides the genitalia, the urinary tract is also prone to contacting the infection. It can be very serious. Sometimes, it can be polymicrobial. Without immediate attention, the microbes may multiple rampantly in the blood stream and lead to internal poisoning. They also affect the lymphatic system.
There are three main types of infection depending on the location.

  • Endometritis: It affects the internal lining of the uterus
  • Metrophlebitis: It affects the uterine veins
  • Peritontiis: It affects the membranous lining of the abdomen

What Are The Symptoms Of A Puerperal Infection?

During pregnancy and especially during and just after delivery, the immune system of the mother is rendered very weak. Puerperal infections most commonly occur within 24 hours to 10 days after delivery -when all that loss of blood and the stress and trauma of delivery naturally weakens the immunity. An infection in the vaginal or the urinary tract during this sensitive period may soon peak to it’s worst. It is extremely vital to note the symptoms of the condition and access medical treatment at the first signs.
Understandably, the new mother is too tired to feel any fever during this time. In addition, postpartum cramps are natural so it is easy to mistake infection symptoms with the cramps. Medical professionals should keep a close watch on the occurrence of the following signs.

  • Foul smelling secretion from the uterus, sometimes it may be consisting of pus
  • High fever greater than 38 degree centigrade or 100.4 degree Fahrenheit
  • Chills
  • Abdominal cramps
  • Tenderness and pain in the uterus
  • Failure of uterus to resume to the normal size
  • Malaise
  • Loss of appetite and headache
  • Constant feeling of tiredness and fatigue
  • Mastitis – during breastfeeding

The symptoms can begin to appear as soon as 24 hours after the infection or it can take up to 10 days to show. Healthcare providers should keep a very close watch on the new mother for at least up to 20 days after childbirth to ensure there is no sign of infection. It must be made mandatory for facilities to maintain maximum hygiene. Hospitals are also hotbeds of infection if it is neglected.

How Is Postpartum Infection Diagnosed?

A physical exam followed by blood and urine tests for bacterial presence and infection will be run by your doctor to diagnose puerperal infections. On suspecting a possible infection, the doctor should obtain a swab very carefully from the vagina or any open wound. Swelling and tenderness of the uterus should serve as immediate alarms. On diagnosis, the physician immediately prescribes broad-spectrum antibiotics unless the actual type of infection is determined. Cold compresses also yield good results.

What Are The Complications Of Postpartum Infections?

Though rare, yet delayed diagnosis and treatment of a puerperal infection can result in complications such as:

  • Developing pus or abscesses
  • Blood clots in the pelvic vein
  • Sepsis if the bacteria enter the bloodstream
  • Inflammation of the abdominal wall

What Are The Risk Factors Of Developing Postpartum Infections?

The chances of developing postpartum infections have been ascertained to the below approximations based on how your delivery takes place:

  1. In normal vaginal deliveries, 1% – 3%
  2. Scheduled C-sections that take place before labor strikes run a risk of 5% – 15%
  3. Emergency C-section deliveries carried after labor starts carry a risk of 15% – 20%

Apart from these, some existing pre-pregnancy or during pregnancy conditions can also make you prone to puerperal infections:

  • Multiple pelvic exams during pregnancy
  • Prolonged labor
  • Anemia
  • Obesity
  • Excessive bleeding
  • Young age and low socio-economic group
  • Parts of placenta left inside the uterus
  • Earlier rupture of amniotic sac

How Can I Avoid Getting Puerperal Infections?

It is a completely preventable occurrence, and no woman should have to suffer from the fever caused by a negligent health facility. Women developing the infection during pelvic examinations are sadly vulnerable to miscarriages. It can also be fatal when ignored. Fortunately, effective antibiotics are available to alleviate the condition. Nowadays the instance of puerperal sepsis is very low because of optimum implementation of medical hygiene. However, it must be made fully sure to avoid all instances of puerperal sepsis.

Choosing the right hospital is critical:

Women should make sure they choose a facility with excellent cleanliness. Family members should also emphasize that doctors follow proper sanitation guidelines when treating the mother. There should be no untrained medical professional touching the pelvic or any other region on the body of the mother

Proper hygienic practices:

Apart from ensuring the complete sanctity of the health facility, the professionals should be extremely careful during the delivery. All equipment should be properly sterilized and all hands must wear medical gloves. Midwives and other professionals must have full training on taking a high vaginal swab, maintaining optimum vulva hygiene, and best practices to obtain a blood culture. Above everything, healthcare professionals must not give in to a sense of callousness stemming from handling numerous deliveries. Every woman is special and unique, deserving of maximum attention

Timely postpartum checkups:

Do not skip postpartum appointments thinking you are too busy and all the discomfort is normal. Make sure that you let your doctor know if something is bothering you or you suspect anything that is not normal

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