Postpartum endometritis: Difference between revisions

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*Any postpartum woman with fever should be assumed to have a genital tract infection
*Any postpartum woman with fever should be assumed to have a genital tract infection


==Risk Factors==
===Risk Factors===
#Cesarean delivery (most important)
#Cesarean delivery (most important)
#Prolonged labor
#Prolonged labor
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#Large amount of meconium in amniotic fluid
#Large amount of meconium in amniotic fluid
#Manual removal of placenta
#Manual removal of placenta
#DM
#[[Diabetes Mellitus]]
#Preterm birth
#Preterm birth
#Bacterial vaginosis
#Bacterial vaginosis
#Operative vaginal delivery
#Operative vaginal delivery
#Post-term pregnancy
#Post-term pregnancy
#HIV infection
#[[HIV]] infection
#Colonization with group B strep
#Colonization with [[Group B Strep]]


==Diagnosis==
==Diagnosis==

Revision as of 06:10, 8 March 2014

Background

  • Any postpartum woman with fever should be assumed to have a genital tract infection

Risk Factors

  1. Cesarean delivery (most important)
  2. Prolonged labor
  3. Prolonged ROM
  4. Internal fetal or uterine monitoring
  5. Large amount of meconium in amniotic fluid
  6. Manual removal of placenta
  7. Diabetes Mellitus
  8. Preterm birth
  9. Bacterial vaginosis
  10. Operative vaginal delivery
  11. Post-term pregnancy
  12. HIV infection
  13. Colonization with Group B Strep

Diagnosis

  1. Fever
  2. Foul-smelling lochia
  3. Leukocytosis
  4. Uterine tenderness
  5. Only scant discharge may be present (esp w/ group B strep)

DDX

  1. Respiratory tract infection
  2. UTI/urosepsis
  3. Pyelonephritis
  4. Intra-abdominal abscess
  5. Mastitis
  6. 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

See Also

Post-Partum Emergencies

Source

  • Tintinalli
  • Rosen's