Management of Puerperal sepsis

If very ill
Septicaemic
in shock
If evidence of in respiratory distress
septicaemia, bleeding tendency
present
Midwifery level Non specialist unit present attend to Manage in ICU
Post partum visits resuscitation and Specialized Unit
transfer
ƒ Assess-signs of shock, septicaemia, anaemia & treat accordingly immediately
Fever/purulent vaginal ƒ Abdominal examination for uterine size and tenderness ƒ Physical examination & Ultrasound to
discharge/pelvic pain ƒ Check for uterine haemorrhage & control it rule out:
ƒ Penicillin 2 million units IV/IM every 6 hours +gentamicin 80mg Pelvic abscess
ƒ Amoxycillin- clavulinic acid -1.2 g intravenous 8 hourly or 625mg oral 8 hourly/bd Pelvic thromboplebitis
ƒ (IV/IM every 8 hourly +metronidazole) 500mg every 8 hours orally. Retained products
Admit ƒ IV fluids-I litre, 5% dextrose or N. saline rapidly followed by ƒ Culture and sensitivity test for vaginal
Assume Puerperal sepsis immediately ƒ 3000 mls every 24 hours. discharge, Gram stain
ƒ Renal,liver, coagulation profiles
ƒ Vital signs every 6 hours ƒ Blood culture
ƒ Continue IV therapy
Amoxycillin- clavulinic acid (Amoxyclav)-
1.2g intravenous 8 hourly with or without
gentamicin
If response is poor,
Imipenem 500 mg intravenous 8 hourly
Very sick (high fever, altered Or
consciousness, rapid pulse-Assume
Admit immediately- Ticarcillin-clavulinic acid 3.2 g
critically ill. If possible accompany the patient intravenous 8 hourly.may be used in place
of Amoxycillin- clavulinic acid
(Amoxyclav).
ƒ Review and change antibiotic based on
Yes Improvement in 24 hours
No sensitivity
Transfer to specialist
hospital
Appropriate management of complications
ƒ Retained placental fragments- Evacuate
Needs an ultrasound to Continue IV antibiotics for 3 days only when the patient is stable.
exclude retained products – No Transfer to specialist ƒ Pelvic abscess,
Placental segments as a cause hospital ƒ Thromboplebitis,
of sepsis
Yes Resolved completely
Refer to specialist unit for
ultrasound or further advice Low risk

At risk
Discontinue IV
Discharge the patient Alarming
Oral antibiotics for 4-7 days
Check haemoglobin and treat anaemia Assessment Sri Lanka College of Obstetrics and Gynaecology
Advice to return if following recurres Health sector development Project
• Fever Referral Guidelines- Management of Puerperal sepsis
• Vaginal discharge
• Pelvic pain