Postpartum endometritis: Difference between revisions

Revision as of 02:11, 25 August 2011

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
DM
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)

DDX

Respiratory tract infection
UTI/urosepsis
Pyelonephritis
Intra-abdominal abscess
Mastitis
Thrombophlebitis

Treatment

Abx
- Outpatient
  - Clindamycin 300mg PO TID
- Inpatient
  - Clindamycin 900mg IV TID + gentamicin 1.5 mg/kg IV TID

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

Source

Tintinalli
Rosen's

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
+*Any postpartum woman with fever should be assumed to have a genital tract infection
-{| width="200" cellspacing="1" cellpadding="1 border="1"
+==Risk Factors==
-| '''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
+#Prolonged ROM
-#Multiple cervical examinations
 #Internal fetal or uterine monitoring
 #Large amount of meconium in amniotic fluid
-#Manual removal of the placenta
+#Manual removal of placenta
-#Low socioeconomic status
+#DM
-#Maternal diabetes mellitus or severe anemia
 #Preterm birth
 #Bacterial vaginosis
 #Operative vaginal delivery
-#Postterm pregnancy
+#Post-term pregnancy
 #HIV infection
-#Colonization with group B streptococcus
+#Colonization with group B strep
-== 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
+==Diagnosis==
+#Fever
+#Foul-smelling lochia
+#Leukocytosis
+#Uterine tenderness
+#Only scant discharge may be present (esp w/ group B strep)
-== Evidence Based Questions ==
+==DDX==
-Insert
+#Respiratory tract infection
+#UTI/urosepsis
+#Pyelonephritis
+#Intra-abdominal abscess
+#Mastitis
+#Thrombophlebitis
-== See Also ==
+==Treatment==
-Insert
+*Abx
+**Outpatient
+***Clindamycin 300mg PO TID
+**Inpatient
+***Clindamycin 900mg IV TID + gentamicin 1.5 mg/kg IV TID
-== Source ==
+==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
-Adapted from Rosen's, Tintinalli's
+==Source==
+*Tintinalli
+*Rosen's
-<br/>[[Category:ID]] <br/>[[Category:OB/GYN]] <br/> <br/><br/>
+[[Category:OB/GYN]]