Postpartum endometritis: Difference between revisions
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''For endometritis unrelated to pregnancy, see [[Pelvic inflammatory disease (PID)]].'' | ''For endometritis unrelated to pregnancy, see [[Pelvic inflammatory disease (PID)]].'' | ||
==Background== | ==Background<ref>Stevens DL and Bryant A. Pregnancy-related group A streptococcal infection.</ref>== | ||
*Any postpartum woman with fever should be assumed to have a genital tract infection | *Any postpartum woman with fever should be assumed to have a genital tract infection | ||
*Postpartum women have a 20-fold increase in invasive group A streptococcal infection compared with nonpregnant women. | |||
*Most often polymicrobial, requiring broad spectrum antibiotics | *Most often polymicrobial, requiring broad spectrum antibiotics | ||
*Maternal mortality is highest if infection develops within 4 days of delivery | |||
===Risk Factors=== | ===Risk Factors=== | ||
*Cesarean delivery (most important) | *Cesarean delivery (most important) | ||
*Prolonged labor | *Prolonged labor | ||
*Prolonged rupture of membranes | *Prolonged or premature rupture of membranes | ||
*Internal fetal or uterine monitoring | *Internal fetal or uterine monitoring | ||
*Large amount of meconium in amniotic fluid | *Large amount of meconium in amniotic fluid | ||
Revision as of 12:19, 23 August 2017
For endometritis unrelated to pregnancy, see Pelvic inflammatory disease (PID).
Background[1]
- Any postpartum woman with fever should be assumed to have a genital tract infection
- Postpartum women have a 20-fold increase in invasive group A streptococcal infection compared with nonpregnant women.
- Most often polymicrobial, requiring broad spectrum antibiotics
- Maternal mortality is highest if infection develops within 4 days of delivery
Risk Factors
- Cesarean delivery (most important)
- Prolonged labor
- Prolonged or premature rupture of membranes
- Internal fetal or uterine monitoring
- Large amount of meconium in amniotic fluid
- Manual removal of placenta
- Diabetes Mellitus
- Preterm birth
- Bacterial vaginosis
- Operative vaginal delivery
- Post-term pregnancy
- HIV infection
- Colonization with Group B Strep
Clinical Features
- Fever
- Foul-smelling lochia
- Leukocytosis
- Uterine tenderness
- Only scant discharge may be present (esp with group B strep)
Differential Diagnosis
- Respiratory tract infection
- UTI/urosepsis
- Pyelonephritis
- Intra-abdominal abscess
- Thrombophlebitis
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Evaluation
- Evaluate for retained products of conception
Management
Antibiotics
<48hrs Post Partum
Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora
- (Prefered first line) Clindamycin 900mg q8hrs PLUS Gentamicin 5mg/kg IV q24hours (same efficacy and more cost effective vs. 1.5mg/kg) or 1.5mg/kg IV q8hrs[2] OR
- Doxycycline 100mg IV PO q12hrs daily PLUS
- Ampicillin/Sulbactam 3g IV q6hrs
- Cefoxitin 2g IV q6hrs daily
>48hrs Post Partum
- Doxycycline 100mg IV or PO q12hrs + Metronidazole 500mg IV or PO q8hrs daily
- Use Metronidazole with caution in breastfeeding mothers its active is present in breast milk at concentrations similar to maternal plasma concentrations
Disposition
- Consult OB/GYN first if are considering outpatient management
- Admit all patients who appear ill, have had a C-section, or underlying comorbid conditions