Postpartum endometritis: Difference between revisions
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===Risk Factors=== | ===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]] | |||
<br /> | <br /> | ||
==Diagnosis== | ==Diagnosis== | ||
*[[Fever]] | |||
*Foul-smelling lochia | |||
*[[Leukocytosis]] | |||
*Uterine tenderness | |||
*Only scant discharge may be present (esp w/ group B strep) | |||
*Evaluate for retained products of conception | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Respiratory tract infection | |||
*UTI/urosepsis | |||
*Pyelonephritis | |||
*Intra-abdominal abscess | |||
*Thrombophlebitis | |||
{{Postpartum emergencies DDX}} | {{Postpartum emergencies DDX}} | ||
==Management== | ==Management== | ||
===[[Antibiotics]]=== | ===[[Antibiotics]]=== | ||
{{Endometritis Antibiotics}} | {{Endometritis Antibiotics}} | ||
| Line 47: | Line 46: | ||
*[[Post-Partum Emergencies]] | *[[Post-Partum Emergencies]] | ||
== | ==References== | ||
*Tintinalli | *Tintinalli | ||
*Rosen's | *Rosen's | ||
Revision as of 06:59, 28 September 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)
- Evaluate for retained products of conception
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
<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[1] 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 outpt management
- Admit all pts who appear ill, have had a C-section, or underlying comorbid conditions
See Also
References
- Tintinalli
- Rosen's
- Watts D et al. Bacterial vaginosis as a risk factor for post-cesarean endometritis. Obstet Gynecol. 1990 Jan; 75(1): 52-8.
- Smaill F et al. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2002;(3):CD000933.
- ↑ 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