1. Infection International Infection

2. International Objectives definition predisposing factors pathophysiology clinical features sites of postpartum infection treatment prevention

3. Infection International Definition: –any patient with fever of 38.5°C 48-72 hours following a vaginal or forceps delivery with uterine tenderness

4. Infection International Incidence and scope: - major cause of maternal death in emerging countries - less frequent with vaginal births - complications include: shock, pelvic abscesses and pelvic thrombosis

5. Infection International Pathophysiology - normal flora of genital tract contains potential pathogens - amniotic fluid and increase in white blood cells during labour

6. Infection International Clinical Features - usually 2-3 days post partum - low grade temperature, lower abdominal pain and uterine tenderness - also: malaise, anorexia, foul lochia - if severe: high temperature and generalized peritonitis

7. Infection International Predisposing factors - trauma and tissue necrosis following deliver creates a culture medium for ascending - cesarean section is most important predisposing - prolonged labour and ruptured membranes - poverty and poor hygiene/nutrition

8. Infection International Bacteria - polymicrobial - most common: Escherichia coli, Kelbsiella, Proteus and Bacteroides fragilis - less common: Clostridium, Staphylococcus aurea and Pseudomona - exogenous source: Group A beta-hemolytic streptococci

9. Infection International Clinical Features - Group A beta-hemolytic stretpococci may be fulminant with peritonitis and septicemia - if cultured, hospital personnel must be screened to try and identify the source

10. Infection International Diagnosis - sites of infection to consider in post partum patient (culture if able): endomyometritis urinary tract episiotomy site abdominal incision breast thrombophlebitis: legs, pelvis appendicitis other: upper respiratory infection

11. Infection International Management - Prevention - correct aseptic technique - antibiotic use in women with cesarean section or prolonged rupture of membranes (1g ampicillin IV given prophylactically in cesarean section reduces infection)

12. Infection International Management -- Treatment mild case: single broad spectrum antibiotic (eg. ampicillin 1 g IV q6h Or orally) if cesarean section: flagyl 500 mg q8h + cefoxitin 2g q6h OR aminoglysocide (gentamycin or tobramycin) 60- 100 mg q8h +clindamycin 900 mg q8h

13. Infection International Management - Treatment if intravenous antibiotics used, continue for 48 hours after fever has stopped. if fever continues and aminoglycoside-clindamycin combination was used, add penicillin (5M units q6h) to cover enterococci oral antibiotics should be used for 5 days

14. Infection International Other issues - the more antibiotics used, > the higher the chance of necrotizing colitis - antibiotics do appear in breast milk but in most cases are not clinically significant (avoid tetracyclines)

15. Infection International Specific issues: episiotomy infection: treat with antibiotics, baths (clean water!), heat - remove sutures if fluctuation or pus - rarely needs debridement necrotizing fascitis: rare, rapid progression of local inflammation followed by gangrene -patient is toxic: high dose antibiotics but MUST surgically DEBRIDE

16. Infection International Other issues - Septic pelvic thrombophlebitis--usually anaerobic sepsis - usually patient is already on antibiotics but continues to have high spiking fevers - diagnosis of exclusion - treatment is intravenous heparin - > condition should respond to heparin

17. Infection International Other issues - Mastitis--penicillin G or penicillinase-resistant (methicillin or cloxacillin) for 7-10 days continue breast feeding! if breast abcess--drain

18. Infection International

19. Infection International

20. Infection International

21. Infection International

22. Infection International

23. Infection International

24. Infection International

25. Infection International

26. Infection International

27. Infection International

28. Infection International

29. Infection International

30. Infection International

31. Infection International

32. Infection International

33. Infection International

34. Infection International

35. Infection International

36. Infection International

37. Infection International

38. Infection International

39. Infection International

40. Infection International

41. Infection International

42. Infection International

43. Infection International

44. Infection International

45. Infection International

46. Infection International

47. Infection International

48. Infection International

49. Infection International

50. Infection International