JOMO KENYATTA UNIVERSITY OF AGRICULTURE AND
TECHNOLOGY
SCHOOL OF NURSING
STUDY YEAR:3RD,1ST TRIMESTER.
UNIT:MID-WIFERY III
UNIT CODE:INS 21
GROUP 2 MEMBERS:
1. JANE KEMUMA HSN211-0049/2017
2. PEARL WAMBUI HSN211-0062/2017
3. BRIAN KITIABI HSN211-0021/2017
4. EKENO FRANCIS HSN211-0064/2017
5. CECILIA NANDWA HSN211-0035/2017
6. NIMO ALI HSN211-
7. RACHEL MUTHEU HSN211-0029/2017
PUERPERAL PYREXIA
Puerperal pyrexia is defined as the rise of temperature reaching 38 degrees Celsius or more on
separate occasion at 24hrs apart(excluding 1st 24hr) within 1st 10 days following delivery.
It is also defined as the presence of fever which is greater than or equal to 38 degrees Celsius in
a woman within 6 weeks of her having given birth.
Aetiology
Specific causes of puerperal pyrexia include:
I. Urinary tract infections which is mostly caused by Escherichia coli,proteus spp and
klebsiella spp.It presents with;dysuria,hematuria.
II. Genital tract infection;which maybe caused by E.coli,streptococcus pyogens,clostridium
welchii.presents with;tender bulky uterus,prolonged bleeding/pink or discoloured
lochia,painful inflamed perineum.
III. Mastitis;usually caused by staphylococcus spp with symptoms of painful,hard,red breast
with abscess,nipple trauma and cellulitis
IV. Postoperative infection following caesarean section;lower segment c/s.Its the most
common risk factor for puerperal pyrexia,there is a significantly increased risk of
postpartum sepsis,wound problems,urinary tract infections and fever following
LSCS(lower segment c/s)
V. Septic pelvic thrombophlebitis which has wide fever swings despite antibiotics.
VI. Deep venous thrombosis;lowgrade pyrexia can be caused by venous thromboembolism
caused by venous stasis and hypercoagulability.
Other causes may include;
Premature rupture of membranes
Retained products of conception
Hemorrhage
Diabetes,obesity
Pulmonary infection
The symptoms with which the mother presents may well provide some ideas of source of the
infection.
Diagnosis can be done through:
a. History taking
A full hx should be taken to include a hx of delivery.That is;
-when the membranes ruptured
-the length of labour
-sutures repaired
-whether the placenta was complete
-whether there was bleeding dUring or after delivery
b. Physical exam
Take the patient’s temperature and blood pressure.
Palpate the uterus to asses size and tenderness.
Examine the breast.
Examine the legs for possible thromboses.
c. Laboratory investigations
High vaginal swab and other swabs as felt necessary e.g wound swabs.
Urine culture and microscopy.
Full blood count.
Blood culture.
Ultrasound scan maybe required to assist diagnose retained product of conception.
Sputum culture if indicated.
Treatment
It begins with antibiotics iv infusion that’s broadspectrum antibiotics and is confined for 48 hrs
after fever is resolved.
Supportive care
-Systematic treatment depending on which infection
Surgery may be necessary to remove any remaining products of conception or to drain local
lesions such as an infected episiotomy may need to be opened and drained.
In the presence of thrombophlebitis,heparin therapy will be needed to provide anticoagulation.
General measures
Ice packs maybe helpful for pain from perineal wounds or mastitis.
Rest and adequate fluid intake are required,particularly breast-feeding mothers.
Complications
1) Genital tract infection may lead to abscess formation,adhesions,peritonitis,hemorrhage
and subsequent infertility if not treated early.
2) Urinary tract infection may progress to pyelonephritis and renal scaring if left untreated.
3) Mastitis leads to formation of breast abscess.
Prevention
Scrupulous attention to hygiene should be used during all examinations and use of
instruments during and after labour.
Use of prophylactic antibiotics during prolonged labour.
Catheterization should be avoided where possible.
Perineal wounds should be cleaned and sutured as soon as possible after delivery.
Early mobilization of delivered mothers will help to protect against venous thrombosis.
New mothers should be helped to acquire the skills required for successful breast-
feeding in order to reduce the risk of mastitis.
