Postpartum endometritis: Difference between revisions
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#[[Diabetes Mellitus]] | #[[Diabetes Mellitus]] | ||
#Preterm birth | #Preterm birth | ||
#Bacterial vaginosis | #[[Bacterial vaginosis]] | ||
#Operative vaginal delivery | #Operative vaginal delivery | ||
#Post-term pregnancy | #Post-term pregnancy | ||
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==Diagnosis== | ==Diagnosis== | ||
#Fever | #[[Fever]] | ||
#Foul-smelling lochia | #Foul-smelling lochia | ||
#Leukocytosis | #[[Leukocytosis]] | ||
#Uterine tenderness | #Uterine tenderness | ||
#Only scant discharge may be present (esp w/ group B strep) | #Only scant discharge may be present (esp w/ group B strep) | ||
== | ==Differential Diagnosis== | ||
#Respiratory tract infection | #Respiratory tract infection | ||
#UTI/urosepsis | #UTI/urosepsis | ||
#Pyelonephritis | #Pyelonephritis | ||
#Intra-abdominal abscess | #Intra-abdominal abscess | ||
#Thrombophlebitis | #Thrombophlebitis | ||
== | {{Postpartum emergencies DDX}} | ||
* | |||
==Management== | |||
*[[Antibiotics]] | |||
**Outpatient | **Outpatient | ||
***[[Clindamycin]] 300mg PO TID | ***[[Clindamycin]] 300mg PO TID | ||
**Inpatient | **Inpatient | ||
***[[Clindamycin]] 900mg IV TID + gentamicin 1.5 mg/kg IV TID | ***[[Clindamycin]] 900mg IV TID + [[gentamicin]] 1.5 mg/kg IV TID | ||
==Disposition== | ==Disposition== | ||
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[[Category:OB/GYN]] | [[Category:OB/GYN]] | ||
[[Category:ID]] | |||
Revision as of 17:05, 10 January 2015
Background
- Any postpartum woman with fever should be assumed to have a genital tract infection
Risk Factors
- Cesarean delivery (most important)
- Prolonged labor
- Prolonged ROM
- 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
Diagnosis
- Fever
- Foul-smelling lochia
- Leukocytosis
- Uterine tenderness
- Only scant discharge may be present (esp w/ 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
Management
- Antibiotics
- Outpatient
- Clindamycin 300mg PO TID
- Inpatient
- Clindamycin 900mg IV TID + gentamicin 1.5 mg/kg IV TID
- Outpatient
Disposition
- Consult OB/GYN first if are considering outpt management
- Admit all pts who appear ill, have had a C-section, or underlying comorbid conditions
See Also
Source
- Tintinalli
- Rosen's