Puerperal infection is a term used to describe any infection of the reproductive tract during the first six weeks of postpartum.

a. Pathology.

When the third stage of labor is completed, the placental attachment site is raw, elevated, and dark red.

The surface is nodular, owing to the numerous veins, and offers an excellent portal of entry for microorganisms.

The uterine decidua is very thin and has many small openings that offer a portal for pathogens. In addition, small cervical, vaginal and perineal lacerations, as well as the episiotomy site, provide entry ports for pathogens. The resultant inflammation and infection can remain localized or can extend via blood or lymph vessels to other tissues.

b. Organisms.

Those organisms recognized as the common causative agents are normally seen in the lower bowel and lower genital tract.

(1) Anaerobic staphylococci.

(2) Anaerobic streptococci.

(3) Clostridium perfringens.

(4) Neisseria gonorrhea.

c. Predisposing Factors.

(1) Prolonged rupture of uterine membranes provides increased opportunity for infection to develop prior to delivery.

(2) Retained placental fragments-provides additional medium for infectious growth.

(3) Postpartal hemorrhage-causes decreased resistance to pathogens.

(4) Preexisting anemia-low resistance to infection.

(5) A prolonged and difficult labor, especially with the involvement of instruments (forceps).

(6) Intrauterine manipulations for fetal delivery or manual expulsion of placenta.

d. Spread of Infectious Microorganisms.

This may be the result of the spread of infectious microorganisms in the hospital setting.

e. Means to Prevent the Spread of Puerperal Infection in Hospitals.

(1) Restrict personnel with respiratory infections from working with patients.

(2) Use caps, mask, gowns, and gloves when working in delivery rooms.

(3) Use sterilized equipment within control dates.

(4) Wash hands meticulously (staff).

(5) Correct breaks in sterile techniques immediately.

(6) Instruct the patient on hand washing and cleansing her perineum from front to back.

(7) Limit unnecessary vaginal exams during labor which increases the chances of introducing organisms from the rectum and vagina into the uterus.

f. Kinds of Postpartal Infections.

(1) Endometritis-invasion of microorganisms into the placental site of the uterine wall.

(2) Pelvic cellulitis (parametritis)-infection that has spread beyond the endometrium into the surrounding pelvic structures including the broad ligament.

(3) Peritonitis-an infection of the peritoneum, either generalized or localized.

(4) Salpingitis-an infection of the fallopian tubes following childbirth.

g. Medical Treatment of Puerperal Infection.

(1) Antibiotics to which the causative organisms are sensitive, analgesics, and sedatives.

(a) Initial antibiotics are given by IV until the fever resolves.

(b) May possibly switch from IV and give oral medication if fever remains normal for 48 to 72 hours.

(c) May use a course of triple antibiotics until all cultures are obtained.

(2) Incision and drainage (I&D) of any abscesses formed.

h. Nursing Care of Puerperal Infection.

(1) Isolation, if possible, the removal of the patient from the maternity ward.

(2) Meticulous hand washing.

(3) Patient placed in Fowler’s position to facilitate drainage.

(4) Reeducation of the patient on handwashing and peri-care.

(5) Emotional support since the patient may be prevented from rooming in with her infant while her temperature is elevated.