11: Puerperal sepsis

Question 1

What is puerperal sepsis?

Answer 1

Infection + systemic manifestations that occur from birth until 6 weeks postnatally

Question 2

DDx post partum fever

Answer 2

GU: genital tract infection, wound infection, endometritis, UTI
CVS/haem: VTE, septic pelvic thrombophlebitis
RS: pneumonia or atelectasis
Other: mastitis

Question 3

Hx and exam for post partum fever

Answer 3

Hx
- onset, # of days PP, delivery history (mode, complications), lochia, pain, associated symptoms, rashes

O/E
- stable or unstable, abdo: obvious wound infection, tender/bulky uterus, lochia, calf swelling

Question 4

Common organisms implicated in puerperal sepsis

Answer 4

Skin: S. aureus, S pyogenes
Resp: S pneumoniae
Gut: E Coli

Question 5

Initial mx of puerperal sepsis

Answer 5

1. ABCDE
2. Septic screen (antibiotics, fluids, o2, lactate, urine, cultures)
3. Try and identify source

Question 6

Components of postnatal check

Answer 6

• General wellbeing + recovery (esp. PND screen)
• Breast feeding
• Urine and bowel habit
• Lochia
• contraception
• Smears

Question 7

When can the COC be started post partum?

Answer 7

Breast feeding - after 6 weeks

Not breast feeding and normal BMI: after 3 weeks

Question 8

What are the conditions of lactational amenorrhoea?

Answer 8

• Fully breast feeding day and night
• Amenorrhoeic
• protection for 6 months