Complications of puerperium

Complications of puerperium

• 1.
  Complications of Puerperium Puerperal pyrexia Problemswith breast feeding Coagulation disorders Psychiatric disorders
• 2.
  1: Puerperal Pyrexia        Genitaltract infection(PUERPERAL SEPSIS) Breast infection Respiratory tract infection Urinary tract infection Thrombophlebitis Wound infection Other causes of pyrexia
• 3.
  a: Puerperal Sepsis       Pyrexiaafter labour or abortion persisting for more than 24 hours One of the major cause of Maternal Mortality and is PREVENTABLE Delivery/abortions without aseptic precautions SIMMELWEIS(Chlorinated water) PASTEUR(microrganisms are responsible) Antibiotics (Sulphonamides 1935,penicillins)
• 4.
  Aetiology      Extensive raw arealeft after placental separation Cervix,vaginal tears Fourchette Perineum Abdominal wound
• 5.
  Micro-organisms        Coliform organisms Enterococcus Anaerobic bacteria Clotridiumwelchii Streptococcus Group B,C,D Staph aureus…resistant strains in hospital staff Hemolytic streptococcus …Group A
• 6.
  Presentation      Mild Pelvic peritonitis General peritonitis Septicemia Pleural,pericardialand joints
• 7.
  Diagnostic work up          Headto toe examination HVS for culture and sensitivity Urine Blood Isolation Barrier nursing Analgesia Hydration Surgical cleaning
• 8.
  b: Urinary tractinfection       Most common cause of puerperal pyrexia E coli Catheterization Treatment : adequate hydration antibiotics
• 9.
  c: Other causes      Respiratorytract infections Others: Tonsillitis Influenza Appendicitis etc
• 10.
  2: Breast feedingproblems
• 11.
  Breast Feeding Practices  BabyFriendly Hospitals  Exclusive breast feeding  Breast feeding within half hour of delivery
• 12.
  Problems in breastfeeding        Engorgement of breasts Cracked nipples Acute Mastitis…staph aureus Breast abscess Suppression of lactation Galactocele(retention cyst) Carcinoma breast
• 13.
  3 :Thromboembolism       Platelet count…rises by 30 % Factor vii,vii and ix also rise Stasis Damage to endothelium Anemia Risk of pulmonary embolism :(No 1 cause of Maternal mortality in West)
• 14.
  Treatment     Prevention Heparin LMWH Oral anticoagulants
• 15.
  4: Psychiatric disorders        Abiochemical change? Physical change in body affecting brain? Psychological stress Concern about baby Experience of labour Change in sexual interest, loss of attractiveness Nausea,backache etc
• 16.
  Minor psychiatric disorders (postpartum blues)       Anxiety ? How to diagnose? Resolution is a must Reassurance Social support Follow up
• 17.
  Neurotic disorders     Anxiety neurosis Depressiveneurosis…tearfulness,insomnia, mood changes Requires…reassurance ,benzodiazepines In severe cases …antidepressants
• 18.
  Puerperal psychosis        Gloomy andself blaming and hopelessness Guilty feeling Hallucinations Suicidal risk Infanticidal attempts Schizophrenia …………………………………………