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POSTPARTUM FEVER

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Title: POSTPARTUM FEVER Author: library3 Last modified by: Neil and Julia Faller Created Date: 5/1/2006 3:06:05 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: POSTPARTUM FEVER


1
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
  • 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
  • Perinealrare, vaginal flora
  • Abdominalvaginal 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
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