Postpartum endometritis
Revision as of 17:05, 10 January 2015 by Rossdonaldson1 (talk | contribs)
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)
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
- Outpatient
- Clindamycin 300mg PO TID
- Inpatient
- Clindamycin 900mg IV TID + gentamicin 1.5 mg/kg IV TID
- Outpatient
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
Source
- Tintinalli
- Rosen's