**2.1.7 Puerperal sepsis**

It is an important cause of AKI. According to World Health Organization puerperal sepsis is defined as infection of the genital tract occurring at any time between the rupture of membranes or labor and the 42 day post partum in which 2 or more of the following are present: pelvic pains, fever oral temperature 38,5°C or higher on any occasion, abnormal vaginal discharge (example presence of pus), abnormal smell or foul odour of discharge, delayed uterine involution. The causative organisms are gram positive streptococcus pyogenes, staphylococcus aureus, coliforms,Chlamydia and Clostridium tetani. (Momoh ,2010)Causes are prolonged rupture of membranes, obstructed labour, frequent vaginal examinations, anemia, caesarean section etc. .The source of infection may be from the retained products of conception where there may be a history of foul smelling lochia and the retained products can be demonstrated on imaging. High vaginal swab culture may help to identify the causative organism. Other sources may be urinary tract infection or mastitis. Hence a detailed physical examination including the breast examination should be undertaken. Treatment consists of appropriate antibiotics according to the culture sensitivity reports. Surgery to remove the retained products or abscess drainage even hysterectomy in extreme cases may be needed.
