Page 297 - Critical Maternity & Newborn Health Nursing

a. Remove any placenta fragments or pieces of membranes blocking the cervix

or attached to uterine wall by ovum or ring forceps after giving ergometrine.

b. Uterine curettage is contraindicated.

4. Treatment of specific infection: e.g. Thrombophlebitis

Nursing Management of Puerperal Sepsis:

• Clinical examination to assess the general condition of the patient, and her

hemodynamic stability.

• Inspection of the external genitalia and perineum to detect any tears or

episiotomy as well as the amount, smell and color of the discharges.

• Assess the size of the uterus as well as the presence of any tenderness by
both abdominal and bimanual examination.

• Use ultrasonography for the detection of any intrauterine contents at the

start and again if the fever persists after the initiation of antibiotics, or if

abdominopelvic masses start to appear.

• Blood culture and sensitivity must be done once you suspect puerperal

sepsis.

• Uterine and high cervical swab might be also taken for culture and

sensitivity.

• Start the most relevant broad-spectrum antibiotics (according to the

currently locally available antibiogram susceptibility pattern prepared by

the H. Antibiotic Committee) until the result of the culture and sensitivity

tests are known. Antibiotics can then be changed to a more specific

alternative.

• Consider evacuation of the intrauterine contents.

• Monitor white blood count every 48 hours or according to the clinical
course.

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