Puerperal sepsis

Clinical Features:: (within 42 days after Delivery

H/O NVD/LUCS ..... days Back.
High Grade Fever t Chil & Rigors.
Excessive Offensive Lochial discharge.
Uterus is subinvoluted and tender.

Cause:
1.Preterm labor
2.Malnutrition and anemia,
3.PROM/ Prolonged Labour
4.Prolonged rupture of membrane hours.
5.Repeated vaginal examinations.
6.Traumatic operative delivery
7.Retained bits of placental
8.Placenta praevia
9.Chronic debilitating illness.
10.Dehydration and keto-acidosis during labor.
11. Cesarean delivery.

Investigation:

Blood for C/S
High vaginal & Endocervical swabs for C/S
Urine R/M/E (Mid-stream)
RBS
S. Electrolyte
USG of W/A
Chest X-ray P/A

Rx in Hospital:

1. Diet: Soft & Liquid (If no Peritonitis)
2. Inf. H/S (1L)+ 5%DNS (1L)
I/V stat @30d/min.

3. Inj. Ceftron(ceftriaxone) (1gm/1Oml)..1 vial /VBD.....7-10 days.

4.Inj. Filmet(metronidazole) 100ml...1 bottel l/V ..TDS...7-10 days.

5.Inj. Gentin (gentamicin)(80mg/2ml) ..1 amp I/V TDS...7 days.

6. Inj. Sergel (esomeprazol)(40mg) ...1 vial i/V BD

7. Tab. Napa(paracetamol) 500mg. ..2+2+2 (A/M)...3-5 days

8.Tab. Vasco DS(ascorbic acid)...........1+0+1...10 days

9.Tab. Xinc -B.......1+0+1.........1 month

10.Continious Catheterization.
11. Blood Transfusion(f Hb% u 10mg/dl)
12. Monitoring Vital Sign.(BP, Pulse, SPO2, Dehydration, U/O)

If Episiotomy/ Perineal tear infected wound:

Stich off (if pus formed)
Hip Bath:

২ লিটার কসুম গরম পানিতে ২-৩ চামচ Povisep solution + ২ চামচ লবন মিশিয়ে দিনে ২বার বসবেন।...১০দিন।

Secondary Stich Given (when wound healthy)

If Retained Placental bit (>3cm):

D&C (after 24 hours of start antibiotics)

If C/S site wound infected:

Regular Dressing
Secondary Stich Given when wound healthy

Another Choice of Antiboitic:

Inj. Neopenam(meropenam) (1gm)

1 vial i/V BD...7-10 days.

Inj. Filmet (metronidazole)(100ml/500mg)

1 bottel I/V TDS..7-10 days.

Inj. Gentin (gentamicin) (80mg/2ml)

1 amp I/V TDS.....7 days.

Protocols