*Postnatal Infection

Question 1

PN check to protect against maternal infection:

PLUM TB

Answer 1

Perineum / Wound
Lochia
Uterine involution
Micturition
Temperature
Breasts

Routine assessment to detect deviations from normal physiological recovery following childbirth.

Question 2

What are ways care providers can prevent maternal infection?

Answer 2

Infection control practices:
* Effective hand-washing
* Aseptic technique
* Gloves
Clippers not razors
ABs pre-op
Vaginal cleansing pre-op
Sutures rather than staples
Wound dressing

Question 3

How to manage abnormal findings during a full postnatal examination?

e.g. raised temp, uterine tenderness, offensive lochia, dysuria

Answer 3

• High vaginal swab
• MSU for MC&S
• ABs
• Fluids, good diet, rest
• Analgesia
• Monitor TPR and symptoms

Question 4

Postnatal advice in relation to infection

Answer 4

Change ice pads regularly (at least 4x daily for first few days)
Blood loss may be heavy for the first few days (should have non-offensive smell)
Contact MFAU if
* Heavier loss / starts to increase, clots
* Bright red after the first week
* Offensive smell

Question 5

What is endometritis?

Answer 5

Inflammation and infection of the endometrium

Question 6

What complications are associated with endometritis?

Answer 6

Can impede uterine involution leading to severe PPH
Sepsis and septic shock

Question 7

Predisposing factors for endometritis are:

Answer 7

• CS
• Pre-term labour
• Poor personal hygiene
• Any procedure or event that introduces infection into the uterus (e.g. PROM, operative VB, manual removal of placenta, repeated VEs, internal EFM)
• Any procedure or event that adversely affects woman’s ability to ward off infection (e.g. PPH, anaemia)

Question 8

Define sepsis

Answer 8

Life-threatening organ dysfunction caused by a dysregulated host response to infection / extreme response to infection

Question 9

Define septic shock

Answer 9

Septic shock is the most severe form of sepsis in which the infection causes low blood pressure, resulting in damage to multiple organs.

Question 10

Signs and symptoms of septic shock?

HOT LAT

Answer 10

Tachycardia >90bpm
Oliguria <0.5ml/kg body weight/hr

Hot, dry skin (or chills)
Oedema
Temperature instability - >38 (possibly with rigors) or <35

Woman looks acutely ill
Acute abdominal tenderness and scanty lochia

Question 11

Management of septic shock

Answer 11

• Collaborative care
• Admit to a hospital which has high-dependency or intensive care facilities.
• MSU, HVS, wound swab, and blood cultures for MC&S
• Take bloods for serum electrolytes, blood urea, FBP, clotting factors.
• Intravenous fluids including blood transfusion if required.
• BP, P, temp, pulse oximetry, level of consciousness.
• IV Abs
• IDC: hourly measurements

Question 12

Aetiology of UTI

Answer 12

Ascending bacterial infection
Overdistension and incomplete emptying of bladder
(Urinary stasis and residual urine - medium for bacterial growth)

Question 13

Signs and symptoms of UTI?

Answer 13

Frequency
* Urgency
* Nocturia
* Haematuria
* Dysuria (painful/difficult urination)
* Pyrexia
* Lower abdo / pelvic pain
* Pyelonephritis manifestations: high fever, chills, flank pain, N&V

Question 14

UTI management

Answer 14

Monitor TPR
MSU
ABs
Increase fluids
Assess bladder function
Educate re: perineal hygiene

Question 15

Mastitis signs and symptoms

Answer 15

Painful, red hot breasts
Chills/fever
Joint aches and pains
Flu-like symptoms

Usually caused by staph aureus or strep

Question 16

Causes of mastitis

Answer 16

• Nipple damage
• Not draining the breasts
• Incorrect attachment
• Infrequent feeding
• Pressure on breast, e.g. tight bra

Question 17

Mastitis management

Answer 17

• Feed on demand
• COLD compress
• Pain relief
• Continue breastfeeding
• Help the milk to flow (e.g. loosen bra and take it off, skin to skin, comfortable position)
• Treat inflammation (e.g. cold packs, pain relief medication)
• Rest and recover (e.g. hydrate, eat well, rest in bed)
• If unable to feed, hand express or pump (hospital grade) for comfort
• Gentle massage (deep massage avoided)
• Cool pack between feeds
• Warm pack just before a feed
• MC&S for EBM and nipple swab
• If chills/fever, start ABs immediately (take probiotics at a different time)
• If no improvement within 12-24hrs, or deterioration, start ABs

Question 18

Perineum/wound signs and symptoms

O-RATS-I

Answer 18

• Odour and discharge
• Redness
• Approximation of wound edges (not approximated not closed together)
• Tenderness (worsening pain)
• Swelling
• Increased temp and pulse

Question 19

Management for suspected peri/wound infection

Answer 19

Swab for MC&S
Pain relief
ABs
Dressings
Educate - Hygiene
Rest, diet, fluids

Question 20

What are the potential ‘sites’ woman can get postnatal infections?

Think of diagram of woman

Answer 20

Breast - mastitis
IVC site
Kidneys - UTI
Epidural site
Uterus - endometritis
CS wound
Peri trauma / epis

Question 21

Risk factors for wound infections

Answer 21

Emergency CS
Previous CS
Chorioamniotitis
BMI >35
ROM (increases each hour)