Puerperal Sepsis


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puerperal sepsis

[pyü′ər·prəl ′sep·səs]
(medicine)
A toxic condition caused by infection in the birth canal, occurring as a complication or sequel of pregnancy.

Puerperal Sepsis

 

an infectious disease that afflicts women in the postnatal period. Infectious agents enter the birth canal of the woman during complicated childbirth. Inflammation of the vagina and of the uterus or the cervix occurs first, and then the infection may become generalized (sepsis). The several stages of puerperal sepsis are determined by the extensiveness and gravity of the infection. In the first stage, infection is limited to an inflammation in the region of the vulvar orifice (postpartum endometriosis, postpartum abscess). In the next stage, the infection extends beyond the vulvar orifice but remains localized (inflammation of periuterine tissue and uterine appendages; thrombophlebitis of the femoral veins and the veins of the uterus and the pelvis). In the third stage, the infection is almost as severe as a generalized one (generalized peritonitis, septic shock, progressive thrombophlebitis). In the last stage of puerperal sepsis, the infection is generalized (sepsis).

Infections of the uterus (endometrioses) are most common. The illness begins three or four days after delivery. Symptoms include exhaustion, weakness, elevation of temperature to 37.5°-38°C, abdominal pains, and increased postnatal discharges. Involution of the uterus is retarded. The illness may last ten to 12 days. If the infection spreads beyond the uterus, the uterine appendages become diseased (salpingoophoritis). Mastitis often develops after the delivery. A special form of puerperal sepsis is septic endotoxin shock, which develops when coliform microbes enter the bloodstream. When the microbes are destroyed, a powerful endotoxin is released, which produces a state of shock. The shock soon gives way to circulatory insufficiency, and the disease often ends with the development of acute renal insufficiency.

Treatment requires hospital care and rest. Antibiotics, sulfanilamides, and anticoagulants may be prescribed. Desensitization therapy may be recommended, along with injection of agents that increase the body’s resistance (fractional transfusions of blood, plasma). With diffuse peritonitis, surgical intervention is required. Prevention includes strict observance of sanitary measures in delivery rooms, detection and treatment of bacillus carriers among medical personnel, and early diagnosis and treatment of incipient forms of the disease.

REFERENCE

Bartel’s, A. V. Poslerodovye infektsionnye zabolevaniia. Moscow, 1973.

A. P. KIRIUSHCHENKOV

References in periodicals archive ?
Most common obstetrical emergencies leading to renal morbidities and associated mortalities were pregnancy induced hypertensive disorders, antepartum and postpartum haemorrhage, ruptured uterus, puerperal sepsis. Appropriate preventive measures such as early identification of at risk women, proper referral for providing multidisciplinary services at the tertiary level, optimization of fluid balance, identification and treatment of cause, delivery at appropriate gestational period, and timely initiation of renal replacement therapy may reduce mortality.
Streptococcal puerperal sepsis and obstetric infections: A historical perspective.
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Definition and Notification of Puerperal Sepsis. Proc R Soc Med.
Patients and Methods All the patients who met with the criteria of puerperal sepsis i.e.
Thirty-three cases without sterile site isolates were included on the basis of [greater than or equal to] l of the following clinical indicators: probable toxic shock syndrome (13 cases), necrotizing fasciitis (15), pneumonia (4), and puerperal sepsis (3).
Puerperal sepsis has shown a decline because of increasing institutional deliveries.
reduction in incidence of puerperal sepsis, chorioamnionitis, neonatal sepsis, which are all increased with prolonged labour.
A study carried out in Mwanza, Tanzania, showed that newborns of mothers who had used the 'Clean Delivery Kits' had 13.1 times less chance of developing cord infections compared to those infants whose mothers did not use a 'Clean Delivery Kit'.10 Similarly, chances of puerperal sepsis were 3.2 times less in mothers who used the kits.10 Another study found that the kit is associated with reduction in umbilical cord and puerperal infections.11 Our survey team found that 78% of the women were not provided with such kits, and no health facility staff had visited them for follow-up treatment.
Objective: To determine the risk factors and complications of puerperal sepsis.
Puerperal sepsis is the fourth leading cause of maternal mortality in South Africa.
The risk of an IUD inserted immediately after childbirth being expelled may be as high as 24%, ACOG noted, and insertion is contraindicated immediately after childbirth for women with peripartum chorioamnionitis, endometritis, or puerperal sepsis.