Puerperal Pyrexia

 Puerperal Pyrexia 

This is defined as a febrile condition occurring within 14-21 days of delivery. In the developed countries of the world and in some developing countries, puerperal pyrexia is a motifiable condition.

 

Causes

1.           Genital tract infection

 

2.           Urinary tract infection

 

3.           Incidental causes such as malaria, amoebic dysentery, typhoid and pneumonia.

 

4.           Breast  engorgement, mastitis or breast abscess

 

5.           Thrombotic condition such as thrombophlebitis and phlebothrombosis.

 

6.           Pyrexia of unknown origin in this case, no cause can be found for the rise in temperature

 

Investigation

 

1.           If the patient has dysuria or there is cause to suspect, a midstream specimen of urine is collected for investigation

 

2.           A high vaginal swab or cervical swab is cultured to exclude genital trace infection.

 

3.           Blood film for malaria parasite and blood culture in case of septicaemia .

 

4.           A chest x-ray and sputum examination should be done if the patient coughs.

 

Management

 

A patient should be made to rest in bed. The temperature should be reduced by fanning and exposure or tepid sponging if the temperature is about 37.90C. Isolate or barrier nurse the patient while investigations are being carried out, the patient should be thoroughly examined for evidence of infection especially in the breast, chest, throat and the genital tract. The type of labour and mode of delivery of the patient are also reviewed.

 

In Nigeria and other countries where malaria is endemic, anti malaria drugs such as chloroquine 800mg stat then 400mg twice daily for 3 days are given in conjunction with the specific treatment after a film have been sent to the laboratory of evidence of malaria parasites. Nursing care include rest, observation, physical care.