Irish Jane B.

Cubillo
III BSN-1

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.
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 inoculum

virulence of the organism

the pelvic tissues affected

the hosts defense mechanisms including general
health and immunologic status




Fever: principal sign

Etiology
Idiopathic

Risk factors:
Related to general infection risk
Related to labor events
Related to operative 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 agents:

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

Clinical Manifestations

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 breast-
feeding if necessary

Treatment

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)


THANK YOU!