Infections in Pregnancytreatment
prevention
Infection
International
Definition:
any patient with fever of 38.5°C 48-72 hours following a vaginal or forceps delivery with uterine tenderness
Infection
International
- less frequent with vaginal births
- complications include: shock, pelvic abscesses and pelvic thrombosis
Infection
International
Pathophysiology
- amniotic fluid and increase in white blood cells during labour
Infection
International
- low grade temperature, lower abdominal pain and uterine tenderness
- also: malaise, anorexia, foul lochia
- if severe: high temperature and generalized peritonitis
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
Bacteroides fragilis
- less common:
- exogenous source:
- 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
Infection
International
Diagnosis
- sites of infection to consider in post partum patient (culture if able):
endomyometritis
- 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)
Infection
International
Management -- Treatment
mild case: single broad spectrum antibiotic (eg. ampicillin 1 g IV q6h Or orally)
if cesarean section:
OR
aminoglysocide (gentamycin or tobramycin) 60-100 mg q8h +clindamycin 900 mg q8h
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
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)
Infection
International
- 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
Infection
International
- Septic pelvic thrombophlebitis--usually anaerobic sepsis
- usually patient is already on antibiotics but continues to have high spiking fevers
- diagnosis of exclusion
Infection
International
for 7-10 days
continue breast feeding!
if breast abcess--drain