Postpartum endometritis: Difference between revisions
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[[Category:ID]] | Adapted from Rosen's, Tintinalli's | ||
[[Category:OB/GYN]] | |||
<br/>[[Category:ID]] <br/>[[Category:OB/GYN]] <br/> <br/><br/> | |||
Revision as of 09:02, 14 June 2011
Background
| RF (+no abx prophy) | Rate |
| Nonelective cesarean | 30% |
| Elective cesarean | 7% |
| Vaginal delivery | 3% |
Risk Factors
- Cesarean delivery (most important)***
- Prolonged labor
- Prolonged rupture of membranes
- Multiple cervical examinations
- Internal fetal or uterine monitoring
- Large amount of meconium in amniotic fluid
- Manual removal of the placenta
- Low socioeconomic status
- Maternal diabetes mellitus or severe anemia
- Preterm birth
- Bacterial vaginosis
- Operative vaginal delivery
- Postterm pregnancy
- HIV infection
- Colonization with group B streptococcus
Diagnosis
- fever
- uterine tenderness
- foul lochia
- mild vaginal bleeding
- NSVD --> late endometritis & polymicrobial
- Csection --> earlier endometrtitis
Work-Up
Fever or sepsis lab workup and cultures
Pelvic Ultrasound
- pelvic fluid collection
- adnexal collection/hematoma
CT AP if neg US and high suspicion
- uterine fluid, debris and gas
DDx
UTI/urosepsis
Intra-abdominal abscess
Septic pelvic vein thrombophlebitis
Pelvic DVT
Treatment
Harbor
- Clinda and Gent
OR
- Ceftriaxona and Gent
Elsewhere
- Zosyn, Unasyn, Ticarcillin/Clavulanate
PCN Allergy
- Ertapenem (preferred), Imipenem
- Clindamycin & Gentamicin
OB consultation for invasive management
Disposition
Nearly all warrant admission to OB-Gyn service
Rarely mild late postpartum endometritis can take PO antibiotics, but this is very rare
Evidence Based Questions
Insert
See Also
Insert
Source
Adapted from Rosen's, Tintinalli's