1. Complications of
Puerperium
Puerperal pyrexia
Problems with breast feeding
Coagulation disorders
Psychiatric disorders

2. 1: Puerperal Pyrexia
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Genital tract infection(PUERPERAL SEPSIS)
Breast infection
Respiratory tract infection
Urinary tract infection
Thrombophlebitis
Wound infection
Other causes of pyrexia

3. a: Puerperal Sepsis
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Pyrexia after 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
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Extensive raw area left after placental separation
Cervix,vaginal tears
Fourchette
Perineum
Abdominal wound

5. Micro-organisms
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Coliform organisms
Enterococcus
Anaerobic bacteria
Clotridium welchii
Streptococcus Group B,C,D
Staph aureus…resistant strains in hospital staff
Hemolytic streptococcus …Group A

6. Presentation
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Mild
Pelvic peritonitis
General peritonitis
Septicemia
Pleural,pericardial and joints

7. Diagnostic work up
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Head to toe examination
HVS for culture and sensitivity
Urine
Blood
Isolation
Barrier nursing
Analgesia
Hydration
Surgical cleaning

8. b: Urinary tract infection
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Most common cause of puerperal pyrexia
E coli
Catheterization
Treatment :
adequate hydration
antibiotics

9. c: Other causes
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Respiratory tract infections
Others:
Tonsillitis
Influenza
Appendicitis etc

10. 2: Breast feeding problems

11. Breast Feeding Practices
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Baby Friendly Hospitals
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Exclusive breast feeding
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Breast feeding within half hour of delivery

12. Problems in breast feeding
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Engorgement of breasts
Cracked nipples
Acute Mastitis…staph aureus
Breast abscess
Suppression of lactation
Galactocele(retention cyst)
Carcinoma breast

13. 3 :Thromboembolism
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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
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Prevention
Heparin
LMWH
Oral anticoagulants

15. 4: Psychiatric disorders
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A biochemical 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
(post partum blues)
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Anxiety ?
How to diagnose?
Resolution is a must
Reassurance
Social support
Follow up

17. Neurotic disorders
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Anxiety neurosis
Depressive neurosis…tearfulness,insomnia,
mood changes
Requires…reassurance ,benzodiazepines
In severe cases …antidepressants

18. Puerperal psychosis
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Gloomy and self blaming and hopelessness
Guilty feeling
Hallucinations
Suicidal risk
Infanticidal attempts
Schizophrenia
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