Julia Faller, D.O., PGY1 Internal Medicine Lecture Series May 3, 2006 POSTPARTUM FEVER Julia Faller, D.O., PGY1 Internal Medicine Lecture Series May 3, 2006
Prelecture questions Puerperium is defined as: Onset of labour through delivery of the placenta Rupture of membranes through 2 weeks postpartum Delivery of the placenta through 6 weeks postpartum 37 weeks gestation through delivery of the placenta
Prelecture questions The most common cause of puerperal fever is: Endometritis UTI Pneumonia Septic pelvic thrombophlebitis
Prelecture questions The most common cause of fever following cesarean delivery is: Perineal cellulitis Abscess formation Atelectasis Endometritis
Puerperium Delivery of the placenta through 6 weeks 6 weeks back to normal state
Anatomic changes Uterus Postpartum bleeding Cervix Vagina Perineum Abdominal wall Ovaries Breasts
Postpartum Fever Infection most common Other causes
Postpartum infection 1-8% of deliveries 4-8% of maternal death Endometiritis most common cause
Risk Factors Cesarean PROM Frequent cervical exams Internal fetal monitoring Preexisting infection Diabetes Nutritional status Obesity
Types of Infection Endometitis Perineal cellulitis Mastitis Anesthesia complications Surgical wound infections UTI Septic pelvic phlebitis
History Type of delivery PROM Symptoms Pelvic exams Beta strep status
Physical Complete Breasts Pelvic Abdomen Back Lungs
Endometritis Ascending polymicrobial infection E. coli, Klebsiella and Proteus Uterus usually sterile Increased risk after cesarean Timing of infection Risk factors History and physical
Treatment of Endometritis IV antibiotics in hospital No consensus on antibiotics Cesarean prophylaxis
UTI Risk factors: E. coli and group B strep Bactrim, cipro, amoxil Type of delivery, tocolysis, induction, renal disease, preeclampsia, epidural, foley E. coli and group B strep Bactrim, cipro, amoxil
Mastitis Inflammation of the mammary gland Staphylococcus aureus 3% Abscess formation Fevers, chills, warmth, swelling, tender Ancef, erythromycin in pt with allergy
Wound Infection Various sites Risk factors Perineal—rare, vaginal flora Abdominal—vaginal flora and/or skin flora Risk factors Diabetes, HTN, obesity, anemia, chorioamnionitis, prolonged labor or ROM, abdominal twin delivery
Wound Infection History: inordinate amount of pain Physical: warm, tender, red, drainage Treatment: Perineal: sitz bath, symptomatic relief Abdominal: drainage, antibiotics
Septic Pelvic Thrombophlebitis Venous inflammation with thrombus formation in association with fevers unresponsive to abx therapy Risk factors: low SES, cesarean, prolonged ROM 1/2000
Septic Pelvic Thrombophlebitis History: often accompanies endometritis Lower abdominal pain Physical: resting tachycardia 50-70% have a palpable ropelike mass
Septic Pelvic Thrombophlebitis Treatment: IV heparin to an aPtt twice normal Long-term anticoagulation not required Continued antibiotic therapy Gentamicin and clindamycin Recent study
Questions Puerperium is defined as: A. Onset of labour through delivery of the placenta B. Rupture of membranes through 2 weeks postpartum C. Delivery of the placenta through 6 weeks postpartum D. 37 weeks gestation through delivery of the placenta
Questions The most common cause of puerperal fever is: A. Endometritis B. UTI C. Pneumonia D. Septic pelvic thrombophlebitis
Questions The most common cause of fever following cesarean delivery is: A. Perineal cellulitis B. Abscess formation C. Atelectasis D. Endometritis
Questions True or False: Atelectasis can cause fever