1. 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

2. 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

3. Prelecture questions The most common cause of puerperal fever is:
Endometritis
UTI
Pneumonia
Septic pelvic thrombophlebitis

4. Prelecture questions
The most common cause of fever following cesarean delivery is:
Perineal cellulitis
Abscess formation
Atelectasis
Endometritis

5. Puerperium Delivery of the placenta through 6 weeks
6 weeks back to normal state

6. Anatomic changes Uterus Postpartum bleeding Cervix Vagina Perineum
Abdominal wall
Ovaries
Breasts

7. Postpartum Fever
Infection most common
Other causes

8. Postpartum infection 1-8% of deliveries 4-8% of maternal death
Endometiritis most common cause

9. Risk Factors Cesarean PROM Frequent cervical exams
Internal fetal monitoring
Preexisting infection
Diabetes
Nutritional status
Obesity

10. Types of Infection Endometitis Perineal cellulitis Mastitis
Anesthesia complications
Surgical wound infections
UTI
Septic pelvic phlebitis

11. History
Type of delivery
PROM
Symptoms
Pelvic exams
Beta strep status

12. Physical
Complete
Breasts
Pelvic
Abdomen
Back
Lungs

13. Endometritis Ascending polymicrobial infection
E. coli, Klebsiella and Proteus
Uterus usually sterile
Increased risk after cesarean
Timing of infection
Risk factors
History and physical

14. Treatment of Endometritis
IV antibiotics in hospital
No consensus on antibiotics
Cesarean prophylaxis

15. 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

16. Mastitis Inflammation of the mammary gland Staphylococcus aureus 3%
Abscess formation
Fevers, chills, warmth, swelling, tender
Ancef, erythromycin in pt with allergy

17. 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

18. Wound Infection History: inordinate amount of pain
Physical: warm, tender, red, drainage
Treatment:
Perineal: sitz bath, symptomatic relief
Abdominal: drainage, antibiotics

19. 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

20. Septic Pelvic Thrombophlebitis
History:
often accompanies endometritis
Lower abdominal pain
Physical:
resting tachycardia
50-70% have a palpable ropelike mass

21. Septic Pelvic Thrombophlebitis
Treatment:
IV heparin to an aPtt twice normal
Long-term anticoagulation not required
Continued antibiotic therapy
Gentamicin and clindamycin
Recent study

22. 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

23. Questions The most common cause of puerperal fever is: A. Endometritis
B. UTI
C. Pneumonia
D. Septic pelvic thrombophlebitis

24. Questions
The most common cause of fever following cesarean delivery is:
A. Perineal cellulitis
B. Abscess formation
C. Atelectasis
D. Endometritis

25. Questions
True or False:
Atelectasis can cause fever