Postpartum endometritis: Difference between revisions

(Created page with "==Background == RF (+no abx prophy) Rate Nonelective cesarean 30% Elective cesarean 7% Vaginal delivery 3% Risk Factors 0) Cesarean delivery (most important)*** 1) Pr...")
 
No edit summary
 
(41 intermediate revisions by 11 users not shown)
Line 1: Line 1:
==Background ==
''For endometritis unrelated to pregnancy, see [[Pelvic inflammatory disease (PID)]].''


==Background<ref>Stevens DL and Bryant A.  Pregnancy-related group A streptococcal infection.</ref>==
*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


RF (+no abx prophy) Rate
===Risk Factors===
Nonelective cesarean 30%
*Cesarean delivery (most important)
Elective cesarean 7%
*Prolonged labor
Vaginal delivery 3%
*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]]


Risk Factors
==Clinical Features==
*[[Fever]]
*Foul-smelling [[vaginal discharge|lochia]]
*[[Leukocytosis]]
*Uterine tenderness
*Only scant discharge may be present (esp with [[group B strep]])


0)  Cesarean delivery (most important)***
==Differential Diagnosis==
*Respiratory tract infection
*[[UTI]]/urosepsis
*[[Pyelonephritis]]
*Intra-abdominal abscess
*[[Thrombophlebitis]]


1) Prolonged labor
{{Postpartum emergencies DDX}}


2) Prolonged rupture of membranes
==Evaluation==
*Evaluate for [[retained products of conception]] (e.g. [[pelvic ultrasound]])


3) Multiple cervical examinations
==Management==
===[[Antibiotics]]===
{{Endometritis Antibiotics}}


4) Internal fetal or uterine monitoring
==Disposition==
 
*Consult OB/GYN first if are considering outpatient management
5) Large amount of meconium in amniotic fluid
*Admit all patients who appear ill, have had a C-section, or underlying comorbid conditions
 
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==
 
 
Insert ==DDx==
 
 
Insert ==Treatment==
 
 
Insert ==Disposition==
 
 
Insert
 
 
==Evidence Based Questions==
 
 
Insert
 


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


==References==
<references/>


Insert
[[Category:OBGYN]]
 
[[Category:ID]]
 
==Source==
 
 
Adapted from ....(insert)
 
 
 
 
[[Category:OB/GYN]]

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"