DIC PUERPERRAL SEPSIS Puerperal sepsis Bacterial infection of

DIC PUERPERRAL SEPSIS

Puerperal sepsis • Bacterial infection of genital tract after delivery. • Organism : polymicrobial • Mode of infection: Exogenous: external sources Endogenous: organism already present in genital tract-anaerobic streptococci. Autogenous: from septic focus in the patient

Puerperal sepsis • Predisposing factors General causes: anaemia, diabetes Local causes: ROM, laceration, retained placenta • Site of infection: Primary: laceration, placental bed, retained tissue Secondary: tubes, ovaries, peritonium, parametrium, pelvic veins

pathology • Localized= putrid endometritis= mild form Infection is limited to the superficial layer of endometrium • Spreading=septic endometritis= severe form The endometrium is the commonest site of puerperal sepsis

Clinical picture • Infected tears: local pain , mild fever, dysuria • Endometritis: fever in the 3 rd day, lower abdominal pain , tender uterus, offensive excessive lochia • Septicaemia: 3 rd or 4 th day, high temp, pulse rapid, lochi is scanty and not offensive • Salpingooophoritis: • Parametritis: 2 nd week • Peritonitis • Pelvic thrombophlebitis: 2 nd week, mild fever,

Investigation • CBC+ Diff WCC • Blood culture • MSU , culture sensitivity • Cervicovaginal swab • Ultrasound • ? X ray chest, widal test, blood film for malaria

ttt • Prophylactic: During pregnancy: ttt anaemia During labour: aseptic condition, VE <, antibiotic if SROM > 18 H, complete delivery of placenta, Puerperium: avoid hospital acquired infection,

ttt • General measures • Antibiotic • Drainage : fowler, semisitting, • Heparin for pelvic vein thrombosis

DIC • Normal fibrinogen 400 -600 mg% • Bleeding from DIC –fibrinogen <=100 mg%

Causes of DIC • • • Abruptio placenta 60 -70% Missed miscarriage IUFD Sepsis AF embolism Severe preeclampsia and eclampsia Massive bleeding Massive blood transfusion Incompatable blood transfusion Acute fatty liver of pregnancy

Diagnosis of DIC • Bleeding per nose , haematuria • Bleeding from puncture sites • PPH • Clot observation test= Weiner test =bed sit test Failure of any clots in 5 ml tube blood within 10 minutes indicate fibrinogen ? 100 mg% If a clot forms the tube incubated at 37 c. If clot dissolves after 30 minutes it means excessive fibrinolytic activity

Diagnosis of DIC • Low fibrinogen • FDP > 40 micrograms/ml • Platelet < 100, 000/cumm • Prothrombin time is increased ( N 10 -15 second) • Thrombin time is increased ( N 25 -35 second) • PTT is increased ( N 25 -35 Second) • Antithrombin 111 deficiency • D-Dimers is increased > 0 -5 microgram/ml is abnormal

Treatment of DIC • Treat the cause: infection-antibiotic • Fresh blood • Fresh FP • Cryoprecipitate • Give platelet if Platelets <50, 000 • Antithrombin 111 adminstration • Heparin to increase fibrinogen

Treatment of DIC Remember • Dextran more than one liter may cause DIC • Dextran interferes with cross matching • One unit platelets raises the platelet count by 10, 000/mm 3 • Each unit cryoprecipitate raise the fibrinogen level by 10 mg/dl • One liter of FFP Supplies 3 gm fibrinogen and all clotting factors