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Page 244
Definition
• Postpartum hemorrhage has been defined as
the loss of 500ml or more blood after the
delivery of the fetus (completion of the third
stage of labor).
• Hemorrhage after the first 24 hours is
designated late postpartum hemorrhage.
Sheehan syndrome
Page 257
definition
• Puerperium: is the postpartum period during
which the pelvic organs return to their
prepregnant conditions
• puerperium infection is a general term used
to describe any bacterial infection of the
genital tract after delivery
• puerperium morbidity:
Puerperium morbidity
• Temperature 38.0 or higher, the temperature
to occur on any 2 of the first 10days
postpartum, exclusive of the first 24 hours,
and to be taken by mouth by a standard
technique at least four times daily.
– Although it is suggests that all puerperal fevers
are the consequence of pelvic infection,
temperature elevations may be the results of
other causes.
Extragenital causes of puerperal fever
• Respiratory complications
• pyelonephritis
• intense breast engorgement
• bacterial mastitis
• thrombophlebitis
• incisional wound abscess
Bacteria commonly responsible for
female genital infections
• Aerobes
– Group A, B and D streptococci
– Enterococcus
– Gram-negative bacteria---E. Coli, Klebsiella
– staphylococcus aureus
• Anaerobes
– peptococcus species
– peptostreptococcus species
– bacteroides bivius, B. Fragilis,B. Disiens
– clostridium species
– fusobacterium species
• others------mycoplasma hominis
– chlamydia trochomatis
Clinical manifestation
• Acute episiotis, vulvovaginitis and cervitis
• metritis(postpartum uterine infection)
– endometritis, endomyometritis,
endoparametritis
– subinvoluted, tenderness, rebound tenderness
– lochia
• adnexal infections: acute salpingitis
• parametrial phlegmen and pelvic abscess
• acute pelvic peritonitis or general peroitonitis
• septic pelvic thrombophlebitis:femoral,saphena
• pyemia and sepsis