Postpartum endometritis: Difference between revisions

No edit summary
No edit summary
 
(40 intermediate revisions by 11 users not shown)
Line 1: Line 1:
==<font size="100%">Background</font>==
''For endometritis unrelated to pregnancy, see [[Pelvic inflammatory disease (PID)]].''


{| class="pbNotSortable" width="200" cellspacing="1" cellpadding="1"
==Background<ref>Stevens DL and Bryant A.  Pregnancy-related group A streptococcal infection.</ref>==
| '''RF (+no abx prophy)<br />'''
*Any postpartum woman with fever should be assumed to have a genital tract infection
| '''Rate'''
*Postpartum women have a 20-fold increase in invasive group A streptococcal infection compared with nonpregnant women.
|-
*Most often polymicrobial, requiring broad spectrum antibiotics
| Nonelective cesarean
*Maternal mortality is highest if infection develops within 4 days of delivery
| 30%
|-
| Elective cesarean
| 7%
|-
| Vaginal delivery
| 3%
|}


'''Risk Factors'''
===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 delivery|Preterm birth]]
*[[Bacterial vaginosis]]
*Operative vaginal delivery
*Post-term pregnancy
*[[HIV]] infection
*Colonization with [[Group B Strep]]


0)� Cesarean delivery (most important)***
==Clinical Features==
*[[Fever]]
*Foul-smelling [[vaginal discharge|lochia]]
*[[Leukocytosis]]
*Uterine tenderness
*Only scant discharge may be present (esp with [[group B strep]])


1) Prolonged labor
==Differential Diagnosis==
*Respiratory tract infection
*[[UTI]]/urosepsis
*[[Pyelonephritis]]
*Intra-abdominal abscess
*[[Thrombophlebitis]]


2) Prolonged rupture of membranes
{{Postpartum emergencies DDX}}


3) Multiple cervical examinations
==Evaluation==
*Evaluate for [[retained products of conception]] (e.g. [[pelvic ultrasound]])


4) Internal fetal or uterine monitoring
==Management==
===[[Antibiotics]]===
{{Endometritis Antibiotics}}


5) Large amount of meconium in amniotic fluid
==Disposition==
 
*Consult OB/GYN first if are considering outpatient management
6) Manual removal of the placenta
*Admit all patients who appear ill, have had a C-section, or underlying comorbid conditions
 
7) Low socioeconomic status
 
8) Maternal diabetes mellitus or severe anemia
 
9) Preterm birth
 
10) Bacterial vaginosis
 
11) Operative vaginal delivery
 
12) Postterm pregnancy
 
13) HIV infection
 
14) Colonization with group B streptococcus
 
==<font size="100%">Diagnosis</font>==
 
<div><font size="3" color="black" face="Lucida Grande"><span lang="EN"><font color="black"><font face="&quot;Lucida Grande&quot;"><font size="12pt">-fever</font></font></font></span></font></div><div><font size="3" color="black" face="Lucida Grande"><span lang="EN"><font color="black"><font face="&quot;Lucida Grande&quot;"><font size="12pt">-uterine tenderness</font></font></font></span></font></div><div><font size="3" color="black" face="Lucida Grande"><span lang="EN"><font color="black"><font face="&quot;Lucida Grande&quot;"><font size="12pt">-foul lochia</font></font></font></span></font></div><div><font size="3" color="black" face="Lucida Grande"><span lang="EN"><font color="black"><font face="&quot;Lucida Grande&quot;"><font size="12pt">-mild vaginal bleeding</font></font></font></span></font></div><div>�</div><div>
 
==<font size="100%">Work-Up</font>==
 
</div><div><font size="100%">Insert</font></div><div>�</div>
 
==<font size="100%">DDx</font>==
 
<div><font size="100%">Insert</font></div><div>�</div>
 
==<font size="100%">Treatment</font>==
 
<div><font size="100%">Insert</font></div><div>�</div>
 
==<font size="100%">Disposition</font>==
 
<font size="100%">Insert</font>
 
==Evidence Based Questions==
 
Insert


==See Also==
==See Also==
*[[Post-Partum Emergencies]]


<font face="inherit"><font size="13px">Insert</font></font>
==References==
 
<references/>
==Source==
 
Adapted from ....(insert)
 
 
 
== Background ==
 
RF (+no abx prophy) Rate Nonelective cesarean 30% Elective cesarean 7% Vaginal delivery 3%
 
<br/>Risk Factors
 
0) Cesarean delivery (most important)***
 
1) Prolonged labor
 
2) Prolonged rupture of membranes
 
3) Multiple cervical examinations
 
4) Internal fetal or uterine monitoring
 
5) Large amount of meconium in amniotic fluid
 
6) Manual removal of the placenta
 
7) Low socioeconomic status
 
8) Maternal diabetes mellitus or severe anemia
 
9) Preterm birth
 
10) Bacterial vaginosis
 
11) Operative vaginal delivery
 
12) Postterm pregnancy
 
13) HIV infection
 
14) Colonization with group B streptococcus
 
 
 
== Diagnosis ==
 
-fever-uterine tenderness-foul lochia-mild vaginal bleeding ==Work-Up==
 
<br/>Insert ==DDx==
 
<br/>Insert ==Treatment==
 
<br/>Insert ==Disposition==
 
<br/>Insert
 
 
 
== Evidence Based Questions ==
 
Insert
 
 
 
== See Also ==
 
Insert
 
 
 
== Source ==
 
Adapted from ....(insert)


<br/>[[Category:OB/GYN]]
[[Category:OBGYN]]
[[Category:ID]]

Latest revision as of 21:39, 6 July 2022

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

Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Evaluation

Management

Antibiotics

<48hrs Post Partum

Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora

>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

See Also

References

  1. ↑ Stevens DL and Bryant A. Pregnancy-related group A streptococcal infection.
  2. ↑ Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015 Feb 2;2015(2):CD001067. doi: 10.1002/14651858.CD001067.pub3. PMID: 25922861; PMCID: PMC7050613
Retrieved from "https://www.wikem.org/w/index.php?title=Postpartum_endometritis&oldid=359661"