Puerperal Infection Nursing Care
Plan & Management
Description
1. Puerperal infection is an infection developing in the birth
structures after delivery.
2. Puerperal infection is a major cause of maternal morbidity
and mortality.
3. The incidence ranges from 14% and to 8% of all deliveries;
there is a higher incidence in caesarean deliveries.
4. The major site of postpartum infections is the pelvic cavity;
other common sites include the breast, urinary tract, and
venous system.
5. Localized infections may affect the vagina, vulva, and
perineum.
6. Endometritis, localized infection of the uterine lining, occurs
48 to 72 hours after delivery.
Aetiology
▪ Puerperal infections can be caused by poor sterile
technique, delivery with significant manipulation, caesarean
birth, or overgrowth of local flora.
Pathophysiology
1. Causative organisms
▪ Aerobic organisms include beta-haemolytic streptococci,
Escherichia coli, Klebsiella, Proteus mirabilis,
Pseudomonas, Staphylococcus aureus, and Neisseria.
▪ Anaerobic organisms include Bacteroides, Pepto
streptococcus, Pepto coccus, and Clostridium perfringens.
2. In parametrises (pelvic cellulitis), infection spreads by way of
the lymphatics of the connective tissue surrounding the
uterus.
, 3. Puerperal infection may extend to the peritoneum by way of
the lymph nodes and uterine wall.
Assessment Findings
1. Clinical manifestations
▪ Puerperal morbidity is marked by a temperature of 38°C
(100.4°F) or higher after the first 24 hours postpartum on
any two of the first 10 postpartum days.
▪ Localized vaginal, valval, and perineal infections are marked
by pain, elevated temperature, oedema, redness, firmness,
and tenderness at the site of the wound; sensations of heat;
burning on urination; and discharge from the wound.
▪ Manifestations of endometritis include a rise in temperature
for several days. In severe endometritis, symptoms include
malaise, headache, backache, general discomfort, loss of
appetite, large tender uterus, severe postpartum cramping,
and brownish red, foul-smelling lochia.
▪ Para metritis (pelvic cellulitis) commonly produces elevated
temperature of more than 38.6°C (102° to 104°F), chills,
abdominal pain, subinvolution of uterus, tachycardia, and
lethargy.
▪ Signs and symptoms of peritonitis include high fever, rapid
pulse, abdominal pains, nausea, vomiting, and restlessness.
Nursing Management
1. Promote resolution of the infectious process.
▪ Inspect the perineum twice daily for redness, oedema,
ecchymosis, and discharge.
▪ Evaluate for abdominal pain, fever, malaise, tachycardia,
and foul-smelling lochia.
▪ Obtain specimens for laboratory analysis; report the
findings.
▪ Offer a balanced diet, frequent fluids, and early ambulation.
▪ Administer prescribed antibiotics or medications; document
the client’s response.
2. Provide client and family teaching. Describe and demonstrate
self-care, stressing careful perineal hygiene and handwashing.
Plan & Management
Description
1. Puerperal infection is an infection developing in the birth
structures after delivery.
2. Puerperal infection is a major cause of maternal morbidity
and mortality.
3. The incidence ranges from 14% and to 8% of all deliveries;
there is a higher incidence in caesarean deliveries.
4. The major site of postpartum infections is the pelvic cavity;
other common sites include the breast, urinary tract, and
venous system.
5. Localized infections may affect the vagina, vulva, and
perineum.
6. Endometritis, localized infection of the uterine lining, occurs
48 to 72 hours after delivery.
Aetiology
▪ Puerperal infections can be caused by poor sterile
technique, delivery with significant manipulation, caesarean
birth, or overgrowth of local flora.
Pathophysiology
1. Causative organisms
▪ Aerobic organisms include beta-haemolytic streptococci,
Escherichia coli, Klebsiella, Proteus mirabilis,
Pseudomonas, Staphylococcus aureus, and Neisseria.
▪ Anaerobic organisms include Bacteroides, Pepto
streptococcus, Pepto coccus, and Clostridium perfringens.
2. In parametrises (pelvic cellulitis), infection spreads by way of
the lymphatics of the connective tissue surrounding the
uterus.
, 3. Puerperal infection may extend to the peritoneum by way of
the lymph nodes and uterine wall.
Assessment Findings
1. Clinical manifestations
▪ Puerperal morbidity is marked by a temperature of 38°C
(100.4°F) or higher after the first 24 hours postpartum on
any two of the first 10 postpartum days.
▪ Localized vaginal, valval, and perineal infections are marked
by pain, elevated temperature, oedema, redness, firmness,
and tenderness at the site of the wound; sensations of heat;
burning on urination; and discharge from the wound.
▪ Manifestations of endometritis include a rise in temperature
for several days. In severe endometritis, symptoms include
malaise, headache, backache, general discomfort, loss of
appetite, large tender uterus, severe postpartum cramping,
and brownish red, foul-smelling lochia.
▪ Para metritis (pelvic cellulitis) commonly produces elevated
temperature of more than 38.6°C (102° to 104°F), chills,
abdominal pain, subinvolution of uterus, tachycardia, and
lethargy.
▪ Signs and symptoms of peritonitis include high fever, rapid
pulse, abdominal pains, nausea, vomiting, and restlessness.
Nursing Management
1. Promote resolution of the infectious process.
▪ Inspect the perineum twice daily for redness, oedema,
ecchymosis, and discharge.
▪ Evaluate for abdominal pain, fever, malaise, tachycardia,
and foul-smelling lochia.
▪ Obtain specimens for laboratory analysis; report the
findings.
▪ Offer a balanced diet, frequent fluids, and early ambulation.
▪ Administer prescribed antibiotics or medications; document
the client’s response.
2. Provide client and family teaching. Describe and demonstrate
self-care, stressing careful perineal hygiene and handwashing.
