Puerperal sepsis- Management

It is the infection of the uterus and surrounding tissues within 6 weeks postpartum manifesting as postpartum metritis, postpartum endometritis, parametritis, peritonitis, or septicaemia.

Clinical presentation

• Fever

• Foul smelling lochia

• Lower abdominal pain or generalized abdominal pain and tenderness

• Delayed involution

Investigations

• Full blood picture and cross matching

• Check LFT, RFT, electrolytes

• Blood culture in case of suspected septicaemia

• Abdominal pelvic ultrasound

Management of puerperal sepsis at dispensary and health center

• Establish IV line and give compound sodium lactate or 0.9% sodium chloride 2 L, then continue as required

  
  

  AND

• Amoxicillin + clavulanic acid (FDC) (PO) 625 mg 12 hourly for 5 days

  
  

  AND

• Metronidazole (PO) 400 mg hourly for 5 days

  
  

  AND

• Gentamicin (IV) 80 mg 12 hourly for 24–48 hours

Referral: resuscitate and refer immediately to hospital for further investigations and management.

Management of puerperal sepsis at hospital

• Blood transfusion in anaemic patients

• Plan interventions such as laparotomy, uterine evacuation, etc. appropriately

• Continue with the above antibiotics for 5–7 days

• Adjust drugs depending on culture and susceptibility results or if not available and there is no improvement after 3 days of treatment with above antibiotics switch to:

• Metronidazole (IV) 500 mg 8 hourly for 5–7 days

  
  

  AND

• Ceftriaxone + sulbactam (FDC) (IV) 1.5 g 12 hourly for 5–7 days

  
  

  OR

• Piperacillin + tazobactam (FDC) (IV) 4.5 g 12 hourly for 5–7 days

Prevention of puerperal infections

• Observation of aseptic technique when performing all obstetric procedures including pelvic examinations during labour

• Administration of prophylactic antibiotics within 1 hour before performing a caesarean section or manual removal of placenta

Prophylactic antibiotics

• Amoxicillin + clavulanic acid (FDC) (IV) 1.2 g stat

  
  

  OR

• Ceftriaxone + sulbactam (FDC) (IV) 1.5 g stat

  
  

  AND

• Metronidazole (IV) 500 mg stat