Puerperal Purpura

Purpura is a condition found but rarely in our pregnant or puerperal patients. It is a serious condition, like any other bleeding condition. When residents talk of purpura in any of our patients, I develop apprehension for the sake of the said patients. It is not that we do not have facilities and expertise to treat these patients. We have both. We have a hematology department with enough doctors and a state of the art laboratory to manage these patients' hematological problems. But I understand that these things do not necessarily guarantee cure and good outcome in every case. Each disease has its own morbidity and mortality despite the best of treatment. "Sir, this patient is suspected to have purpural sepsis" my Registrar told me during ward rounds. I looked at the patient with a combination of apprehension and confusion. The apprehension was for reasons explained before. The confusion was because I had not known anything called purpural sepsis. Purpura may develop in a septic condition, but 'purpural sepsis' was beyond my comprehension. The patient seemed OK. She had no purpura on the skin visible to us. Perhaps it was in the parts covered by her clothes. "Why do you suspect she has this condition?" I asked, avoiding to say 'purpural sepsis'. "Sir, she delivered yesterday. She has fever and leukocytosis." "Where is the purpura?" I asked, hoping against hope she would not have any. "Purpura ...." the Registrar was confused. Why was I talking about purpura? "There is no purpura. She has purpural sepsis." Then I recalled suddenly that another resident a few years ago had also been talking about 'purpural sepsis' which had turned out to be puerperal sepsis. An external examiner from the same geographic region had also been talking about 'purpural' conditions. I looked at my Registrar's face carefully. I realized that the current and past Registrars had similar facial features and probably hailed from the same community. Perhaps they found the pronunciation of the word 'puerperal' difficult and preferred to call it 'purpural'. "Do you mean 'puerperal?' I asked, "as up to 6 weeks after delivery?" "Yes, Sir" she said. "That is puerperium. You have to say 'puerperal sepsis', not 'purpural sepsis'." "OK" she said, sounding like 'if you say so'. I am sure if she writes blogs, she will write about me perhaps someone else she met in past who called it 'puerperal' rather than 'purpural'.