 

Infection of the lining of the uterus – the ENDOMETRIUM
Bacteria gain access to the vagina and enters the uterus
either at the time of birth or during the postpartal period
Inflammation of the endometrium
Endometrisis may occur with birth but infection is usually
associated with chorioamnionitis and a CS birth
Ascending infection reaches the uterus and fetus
ASSESSMENT
Fever on the 3rd / 4th postpartal day
Temp over 100.4℉ (38℃) for consecutive 24 hr period
Chills
Loss of appetite / Anorexia
General malaise
Tender and not well contracted uterus
LOCHIA – dark brown, foul odor, increased in amt
because of poor uterine involution
SONOGRAM – confirm retained placental fragments
THERAPEUTIC MANAGEMENT
Culture
Antibiotic: CLINDAMYCIN (Cleocin)
Oxytocic agent: METHYLREGONOVINE to encourage uterine
contraction
Analgesic for afterpains
Drink additional fluid
Semi-fowler’s / sitting / walking encourages lochia
drainage by gravity – prevents pooling of infected
secretions
Good handwashing
Use gloves in changing perineal pads and linens
Health teaching prior to discharge to determine s/sx of
endometrisis
 Endometrisis can lead to TUBAL SCARRING & interference
with future fertility
 Can lead to PERITONITIS and THROMBOPLEBITIS
Suture line on the perineum from an episiotomy or a
laceration repair becomes the portal of entry for bacterial
invasion
ASSESSMENT
Inflammation on the suture line  pain, heat
Feeling of pressure
Open suture line
Purulent drainage
THERAPEUTIC MANAGEMENT
Culture the drainage using sterile cotton tipped
applicator
Antibiotic: systemic or topical
Analgesic: to relieve discomfort
Removal of perineal sutures to allow for drainage
Sitz bath
Warm compresses
Hubbard tank treatments to hasten drainage & cleanse
the area
Change perineal pads frequently
Wipe from front to back after urinating or bowel
movement
Proper hand washing

Infection of the peritoneal cavity, usually as an extension
of endometrisis
One of the gravest complications of child bearing and is a
MAJOR CAUSE OF DEATH from PUERPERAL INFECTION
The infection spreads from the uterus through the
lympathic system or directly through the fallopian tubes
or uterine wall to the peritoneal cavity

ASSESSMENT
Rigid abdomen
Abdominal pain
High fever
Rapid pulse
Vomiting
Appearance of being acutely ill

THERAPEUTIC MANAGEMENT
Insertion of NGT to prevent vomiting & to rest the bowel
IVF
Total parenteral nutrition
Analgesics
Antibiotic IV

 Peritonitis can interfere with future fertility because it

can leave scarring and adhesions in the peritoneum
 
Infection of the breast; may occur as the 7th postpartal
day or not until the baby is weeks or months old
The organism causing the infection usually enters through
cracked and fissured nipples
Occasionally, the organism that causes mastitis comes
from the nasal oral cavity of the infant. In these instances,
the infant has usually acquired staphylococcus aureus, or
candidiasis while in the hospital
MEASURES TO PREVENT NIPPLE FROM CRACKING
❑ Making certain that the baby is positioned correctly and
grasp the nipple properly, including both the nipple and
areola
❑ Helping a baby release grasp on the nipple before
removing the baby from the breast
❑ Washing hand in-between handling perineal pads and
touching the breasts
❑ Exposing the nipples to air for at least part of everyday
❑ Possibly using Vit-E ointment daily to soften nipples
❑ Encouraging women to begin breastfeeding on an
unaffected nipple
ASSESSMENT
Usually unilateral, or bilateral
Painful, swollen, reddened breast with accompanying
fever and scanty breast milk
THERAPEUTIC MANAGEMENT
Antibiotic effective against penicillin resistant
staphylococci such as DICLOXACILLIN or
CEPHALOSPHORIN
Cold or ice compress and supportive bra helps relieve
pain
Warm, wet compresses can be helpful in reducing
inflammation & edema
If left untreated, a breast infection can become a
LOCALIZED ABSCESS. If an abscess forms, breastfeeding on
that breast is discontinued. As the abscess needs incision
& drainage.
Encourage the woman to pump breast milk, if possible,
until the abscess has been resolved in order to preserve
breastfeeding
 BF is possible with mastitis
 Not necessarily associated with breast cancer but they
have similar s/sx
A woman catheterized at the time of labor or during the
postpartal period is prone to develop UTI because bacteria
may be introduced into the bladder
Pushing with labor may also have allowed secretions to
enter the urinary urethra
ASSESSMENT
Burning on urination
Hematuria
Feeling of frequency or that she always has to void
Pain feels so sharp on voiding that she may resist voiding
Low grade fever
Discomfort from lower abdominal pain
THERAPEUTIC MANAGEMENT
Obtain a clean-catch urine specimen
SULFA DRUGS are usually prescribed for UTI but they are
contraindicated for BF women because they cause
neonatal jaundice
Broad spectrum antibiotics such as AMOXICILLIN or
AMPICILLIN for postpartal UTI ► 5-7 days as prescribed
Drink large amt of fluid (a glass every hr) to help flush
infection in the bladder
Oral analgesics such as ACETAMINOPHEN (Tylenol)

ASSESSMENT
a Woman voids longer than usual time ( > 8 hours ) after
birth or between voids, or does not void at all
If first voiding is < 100 mL, suspect urinary retention
Voids frequently in small amounts; inadequate overall
output
Catheterization using foley catheter; strict aseptic
technique – insert gently
THERAPEUTIC MANAGEMENT
Provide explanation regarding catheterization
After 24 hrs, the IC is usually clamped for a short time
and then removed
Encourage a woman to void by the end of 6 hrs after
removal of the catheter by offering fluid
Administer analgesics
If the woman has not voided by 8 hrs after catheter
removal, she may need reinsertion of IC for an additional
24 hrs
 ►
PLEBITIS ▬ inflammation of the lining of a blood vessel
THROMBOPLEBITIS ▬ inflammation with the formation of
blood clots. In PP, it is an extension of an endometrial
infection
It tends to occur for the ff reasons:
• The fibrinogen level is still elevated from pregnancy,
leading to increased blood clotting
• Dilatation of lower extremity veins is still present as a
result of pressure during pregnancy and birth
The relative inactivity of the period or a prolonged time
spent in the delivery or birthing room stirrups leads to
pooling, stasis, and clotting of blood in the lower
extremities
RISK FACTORS
Obesity
Have varicose veins
Previous thrombophlebitis
> 30 yrs of age w/ increased parity
High incidence of thrombophlebitis in the family
◄
The femoral, saphenous or popliteal veins are involved
An accompanying arterial spasm often occurs, diminishing
arterial circulation to the leg as well
The decreased circulation, along with edema, gives the leg
a white or drained appearance
Formerly called “MILK LEG”
ASSESsMENT
Symptoms present abt 10 days after birth
Elevated temperature
Chills
Pain
Unilateral localized symptoms such as redness, swelling,
warmth & a hard inflamed vessel in the affected leg
Swelling below the point at which venous circulation is
blocked
Shiny & white skin from stretching due to swelling
[Arterial Spasm]
HOMAN’S SIGN ▬ pain in the calf of the leg on
dorsiflexion of the foot

 Doppler ultrasound or contrast venography to confirm

CLASSIFICATION diagnosis
Superficial vein disease (SVD)
Deep vein disease
THERAPEUTIC MANAGEMENT
B ▬ breasts R ▬ redness Bed rest with the affected leg elevated
U ▬ uterus E ▬ edema Bed cradle over the leg can lift the pressure ▬ both
B ▬ bladder E ▬ ecchymosis decrease the sensitivity of the leg & improve circulation
B ▬ bowel D ▬ discharge/drainage Application of moist heat
L ▬ lochia/laceration A ▬ approximation Warm compresses
E ▬ episiotomy Assess the woman for risk of a pressure ulcer
Provide good back, buttocks and heel care for as long as
H ▬ Homan’s sign
she is on bed rest
E ▬ emotion
Antibiotic treatment
Anticoagulant such as Unfractioned Heparin (IV) or low-
(+) Homan’s sign indicates molecular-weight Heparin (SQ)
thromboplebitis Thrombolytics dissolves blood clots; should be initiated
24 hrs for best results
Streptokinase, Alteplase, Urokinase, Reteplase
THERAPEUTIC MANAGEMENT
Good aseptic technique
 NEVER MASSAGE the skin over the clotted area bcs this
Ambulation and limiting the time a woman remains in
could loosen the clot, causing a pulmonary or cerebral
obstetrics stirrups; encourage circulation → promotes
embolism
venous return, decreases the probability of clot
formation
BLOOD COAGULATION STUDY ▬ Heparin therapy is usually
Avoid wearing constricting clothing
continued until symptoms resolve and the International
Ensure a well padded stirrups
Normalized Ration (INR) is > 2 for at least 24 hrs
Wear support stockings for the first 2 weeks after deliver
This must be on-hand!
→ helps increase venous circulation & prevent stasis
• PROTAMINE SULFATE ▬ Heparin antagonist
• Put on SS (compression stockings) before rising in the
• VITAMIN K ▬ Warfarin antagonist
morning
• Remove the SS twice daily & assess skin underneath
 DISCONTINUE if woman is taking COUMADIN!
for mottling or inflammation
Assess signs of bleeding: bleeding gums, ecchymosis spots
in the skin, oozing from episiotomy site
Monitor and document lochia: Lochia increases in woman
receiving anticoagulant. “Lochia serosa w/ scattered
pinpoint clots; 3 potential pads in 8 hrs”
► ◄ 
Involves the ovarian, uterine, or hypogastric vein Obstruction of the pulmonary artery by a blood clot
Usually follows a mild endometrisis & occurs later than A complication of thrombophlebitis when a blood clot
femoral thrombophlebitis, often around the 14th or 15th moves from a leg vein to the pulmonary artery
day of the puerperium
Causes partial obstruction which leads to slowed blood ASSESSMENT
flow & clots in the stagnate blood in the vessel Chest pain  sudden, sharp
Risk factors same as femoral thromboplebitis Tachypnea, tachycardia, orthopnea (inability to breath
except in upright position)
ASSESsMENT Cyanosis
High fever, chills, abdominal pain, general malaise
Severe infection: pelvic abscess, in severe instances: it can  THIS IS AN EMERGENCY! HIGH RISK FOR
become systemic & result in lung, kidney or heart valve CARDIOPULMONARY ARREST!
abscess

THERAPEUTIC MANAGEMENT THERAPEUTIC MANAGEMENT

Total bed rest Oxygen administration
Analgesics Her condition is extremely guarded until the clot can be
Antibiotics lysed or adheres to the pulmonary artery wall and is
Anticoagulants reabsorbed
LAPAROTOMY ▬ if abscess forms ICU for continuing care
Surgery to remove affected vessels
Non constricting clothing in the lower extremities
Resting with feet elevated
Ambulating daily
Teach preventive measure to reduce risk of occurrence
with future pregnancies