High mortality rates are generally half a century ago has three main reasons

Generally, a measure used to assess the merits of the state of obstetric care (maternity care) within a country or region is maternal death (maternal mortality).

• Generally, a measure used to assess the merits of the state of obstetric care (maternity care) within a country or region is maternal death (maternal mortality).

• According to the WHO definition of "maternal mortality is the death of a woman during pregnancy or within 42 days after the end of pregnancy in any way, regardless of the parents of pregnancy and the actions taken to terminate the pregnancy".

High mortality rates are generally half a century ago has three main reasons:

• High mortality rates are generally half a century ago has three main reasons:

• (1) is still a lack of knowledge about the causes and prevention of important complications in pregnancy, childbirth, and childbirth;
• (2) lack of understanding and knowledge about reproductive health, and
• (3) less prevalence of good obstetric care for all pregnant. One of which belongs to the important causes of maternal mortality is puerperal sepsis

Although Semmelweiss in 1874 already showed that puerperal sepsis caused by infection and that doctors and midwives are often the carriers of the infection in women who are birthing, but still a long way in the 20th century this has not been generally accepted among doctors.

• Although Semmelweiss in 1874 already showed that puerperal sepsis caused by infection and that doctors and midwives are often the carriers of the infection in women who are birthing, but still a long way in the 20th century this has not been generally accepted among doctors.

Only after the advancement of microbiological sciences demonstrated that the main cause of the disease are different types of bacteria (streptococcus), that the germs are carried by a doctor, midwife, or other personnel who attended the delivery

• Only after the advancement of microbiological sciences demonstrated that the main cause of the disease are different types of bacteria (streptococcus), that the germs are carried by a doctor, midwife, or other personnel who attended the delivery

• However, the occurrence of sepsis reduction is achieved with the discovery of new drugs that have antibiotic functions "Narrow Spectrum" and "Broad Spectrum."

Puerperium is the period that begins after the placenta was born after 6 weeks (42 days) to return to normal reproductive or pre-pregnancy state.

• Puerperium is the period that begins after the placenta was born after 6 weeks (42 days) to return to normal reproductive or pre-pregnancy state.

The uterine cavity is normally free of bacteria during pregnancy.

• The uterine cavity is normally free of bacteria during pregnancy.

• Approximately 48 hours postpartum, progressive necrosis of the endometrial and placental remnants produces a favorable intrauterine environment for the multiplication of aerobic and anaerobic bacteria.

Endomyoparametritis is a potentially life-threatening condition.

• Endomyoparametritis is a potentially life-threatening condition.

• It commonly begins with:

• Retention of secundines (placental and amniochorionic membrane fragments) that block the normal lochial flow,

• Allowing accumulation of intrauterine lochia,

• Which in turn changes the local BH.

• And acts as a culture medium for bacterial growth.

The body's normal defense mechanisms that can prevent the occurrence of a progressive infection, but decreased defense mechanisms (imunocompromise) enables microorganisms (bacteria) to invasion into endometrium or myometrium.

• The body's normal defense mechanisms that can prevent the occurrence of a progressive infection, but decreased defense mechanisms (imunocompromise) enables microorganisms (bacteria) to invasion into endometrium or myometrium.

• A rise of temperature of 100.4 ° ​​F (38 ° C) or higher that lasts longer than 2 consecutive days (not including the first day postpartum) during the first 10 days postpartum.

further invasion into the lymphatics of the parametrium can cause: lymphangitis, pelvic cellulitis.

• further invasion into the lymphatics of the parametrium can cause: lymphangitis, pelvic cellulitis.

• Infection during childbirth have clinical manifestations increased body temperature (fever), and increased pain around the uterus and lower abdomen.

When developing these infections erratic body temperature, increased with fluctuations, it is a sign of Systemic Inflammatory Response Syndrome occurs (SIRS) onset of sepsis.

• When developing these infections erratic body temperature, increased with fluctuations, it is a sign of Systemic Inflammatory Response Syndrome occurs (SIRS) onset of sepsis.

• Puerperal sepsis at the time was still significantly contribute to postpartum maternal morbidity and mortality.

Clinical syndrome that occurs by excessive body response due to stimuli Microorganisms products.

• Clinical syndrome that occurs by excessive body response due to stimuli Microorganisms products.

• SIRS + Infection.

Hyperthermi / Hypothermi

• Hyperthermi / Hypothermi

• (> 38,3 0C / < 35,6 0C )

• Tachypneu ( resp > 20 / mnt )

• Tachycardi ( pulse > 100 / mnt )

• Leukocytosis > 12000 / mm

• Leukopenia < 4000 / mm

• 10% > cell immature

• Suspected infection

• Blood Glucose > 120 mg/dL (without diabetes)

• Mental status disorders

1. SIRS, caracterized with two or more following symptom :

• 1. SIRS, caracterized with two or more following symptom :

• Hyperthermia/ Hypothermia (> 38,3 0C / < 35,6 0C )
• Tachypnoe ( resp > 20 / mnt )
• Tachycardia ( pulse > 100 / mnt )
• Leucocytosis >12000/mm atau Leucopenia < 4000/mm
• 10% > immature cell

• 2. SEPSIS

• SIRS that has a proven or suspected infection

• 3. SEVERE SEPSIS

• Sepsis with one or more sign of Multi Organ Disfunction syndrome (MODS)/ Multi organ Failure (MOF), Hypotension, oligouria or anuria.

• 4. SEPSIS with Hypotension

• Sepsis with hypotension ( systolic blood Pressure (SBP) < 90 mmHg or reduced SBP > 40 mmHg).

• 5. SEPTIC SHOCK

• septic shock as subset of severe sepsis difined as sepsis-induced hypotension persistently despite adequate fluid resuscitation along with the presence of tissue hypoperfusion.

Good ananemsa to eliminate other causes of fever are caused by the purpurium.

• Good ananemsa to eliminate other causes of fever are caused by the purpurium.

• Physical examination.

• Laboratory investigations:

• Aerobic and anaerobic cultures should be obtained from the blood, endocervix, and uterine cavity,
• Urine specimens for culture
• Complete blood

• CTS or abdominal pelvic ultrasound scan.

di HCU (High Care Unit) Penyakit Dalam RSUD Dr.Moewardi Surakarta

• di HCU (High Care Unit) Penyakit Dalam RSUD Dr.Moewardi Surakarta

• NONMEDIKAMENTOSA

• MEDIKAMENTOSA

Total bed rest, the position depending on the condition of the patient's illness

• Total bed rest, the position depending on the condition of the patient's illness

• Oxygenation 3-4 lt

• DC Plug

• If the patient is unconscious or inadequate intake and gastro intestinal massive bleeding, plug NGT for bleeding and evacuation sonde diet.

Fluid resuscitation

• Fluid resuscitation

• Changes in sepsis hemodynamic
• capillary permeability 
• Liquid come out  interstitial space
• Reduced intravascular fluid
• Dilation of blood vessels  resistance ↓
• decreased blood pressure  shock
• Restoration of intravascular volume
• Colloid + crystalloid

At purpuralis, frequent infections causing sepsis.

• At purpuralis, frequent infections causing sepsis.

• Need to be careful, because it has a high mortality rate.

• Precision / accuracy for detecting "purpuralis infection" to sepsis.

• Immediately take action in accordance with a protocol that has been done as these above.