Infections in PregnancySterilize with steam autoclave or hot-air oven
Preferable over disinfection for “critical” instruments
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Boiling for 20 minutes, completely covered with water
Chemical: bleach 1:50 dilution for 20 minutes… corrosive to stainless steel
Childbirth Education Slide – encourage the use of prenatal classed as a means of reducing the need for analgesia and improving satisfaction with delivery.
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ANTISEPTICS
iodine/iodophor
.Continuous Support Slide – Continuous support to provide direct care and comfort for a labouring woman reduces the length of labour, the need for epidural analgesia and the caesarean section rate. Just having someone in the room, observing but not interacting with the patient, has a similar although less profound effect.
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Disinfect area with bleach 1:100 dilution
Wear gloves
Exam tables should be disinfected daily
Comfort Measures Slide – illustrates that all the discomforts of labour (such as nausea, sleeplessness, bladder distention, various aches and pains) warrant attention and that by easing them or providing “innocuous stimulation” like TENS the need for more significant analgesia may be reduced
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Objectives
definition
treatment
prevention
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Definition:
any patient with fever of 38.5°C 48-72 hours following a vaginal or forceps delivery with uterine tenderness
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- less frequent with vaginal births
- complications include: shock, pelvic abscesses and pelvic thrombosis
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Pathophysiology
- amniotic fluid and increase in white blood cells during labour
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Predisposing factors
- trauma and tissue necrosis following deliver creates a culture medium for ascending
- cesarean section is most important predisposing
- prolonged labour and ruptured membranes
- poverty and poor hygiene/nutrition
Bacteroides fragilis
- less common:
- exogenous source:
- low grade temperature, lower abdominal pain and uterine tenderness
- also: malaise, anorexia, foul lochia
- if severe: high temperature and generalized peritonitis
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- Group A beta-hemolytic stretpococci may be fulminant with peritonitis and septicemia
- if cultured, hospital personnel must be screened to try and identify the source
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Diagnosis
- sites of infection to consider in post partum patient (culture if able):
endomyometritis
- correct aseptic technique
- antibiotic use in women with cesarean section or prolonged rupture of membranes (1g ampicillin IV given prophylactically in cesarean section reduces infection)
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Management -- Treatment
mild case: single broad spectrum antibiotic (eg. ampicillin 1 g IV q6h Or orally)
if cesarean section:
OR
aminoglysocide (gentamycin or tobramycin) 60-100 mg q8h +clindamycin 900 mg q8h
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Management - Treatment
if intravenous antibiotics used, continue for 48 hours after fever has stopped.
if fever continues and aminoglycoside-clindamycin combination was used, add penicillin (5M units q6h) to cover enterococci
oral antibiotics should be used for 5 days
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Other issues
- the more antibiotics used, > the higher the chance of necrotizing colitis
- antibiotics do appear in breast milk but in most cases are not clinically significant (avoid tetracyclines)
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- remove sutures if fluctuation or pus
- rarely needs debridement
necrotizing fascitis: rare, rapid progression of local inflammation followed by gangrene -patient is toxic: high dose antibiotics but MUST surgically DEBRIDE
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- Septic pelvic thrombophlebitis--usually anaerobic sepsis
- usually patient is already on antibiotics but continues to have high spiking fevers
- diagnosis of exclusion
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for 7-10 days
continue breast feeding!
if breast abcess--drain
Postpartum or postabortal septic shock
definition: any toxic patient who has hemodynamic or acid base changes with fever 38.5ºC (after abortion, vaginal or operative delivery)
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- usually gram-negative bacteria (eg. E. Coli) and occasionally gram positive (staphylococci, anaerobic streptococci, clostridium)
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- not fully understood
vascular damage and vasodilatation
AZT 300mgs p.o 3hourly till delivery
AZT 300mgs p.o B.D for 7 days
4mgs/kg p.o B.D for 7 days
2. None
none
Ongoing Care
Counseling and support
Care of the Neonate,(Exclusive breast feeding for 3/12 months or Artificial infant feeding)
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Conclusion
Effective counseling ,support,treatment of opportunistic infections and anti retroviral treatment can improve quality of life.
Antepartum Intrapartum Post partum