POSTPARTUM FEVER

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POSTPARTUM FEVER

• Julia Faller, D.O., PGY1
• Internal Medicine Lecture Series
• May 3, 2006

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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

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Prelecture questions

• The most common cause of puerperal fever is
• Endometritis
• UTI
• Pneumonia
• Septic pelvic thrombophlebitis

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Prelecture questions

• The most common cause of fever following cesarean
  delivery is
• Perineal cellulitis
• Abscess formation
• Atelectasis
• Endometritis

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Puerperium

• Delivery of the placenta through 6 weeks
• 6 weeks back to normal state

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Anatomic changes

• Uterus
• Postpartum bleeding
• Cervix
• Vagina
• Perineum
• Abdominal wall
• Ovaries
• Breasts

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Postpartum Fever

• Infection most common
• Other causes

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Postpartum infection

• 1-8 of deliveries
• 4-8 of maternal death
• Endometiritis most common cause

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Risk Factors

• Cesarean
• PROM
• Frequent cervical exams
• Internal fetal monitoring
• Preexisting infection
• Diabetes
• Nutritional status
• Obesity

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Types of Infection

• Endometitis
• Perineal cellulitis
• Mastitis
• Anesthesia complications
• Surgical wound infections
• UTI
• Septic pelvic phlebitis

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History

• Type of delivery
• PROM
• Symptoms
• Pelvic exams
• Beta strep status

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Physical

• Complete
• Breasts
• Pelvic
• Abdomen
• Back
• Lungs

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Endometritis

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

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Treatment of Endometritis

• IV antibiotics in hospital
• No consensus on antibiotics
• Cesarean prophylaxis

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UTI

• Risk factors
• Type of delivery, tocolysis, induction, renal
  disease, preeclampsia, epidural, foley
• E. coli and group B strep
• Bactrim, cipro, amoxil

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Mastitis

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

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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

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Wound Infection

• History inordinate amount of pain
• Physical warm, tender, red, drainage
• Treatment
• Perineal sitz bath, symptomatic relief
• Abdominal drainage, antibiotics

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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

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Septic Pelvic Thrombophlebitis

• History
• often accompanies endometritis
• Lower abdominal pain
• Physical
• resting tachycardia
• 50-70 have a palpable ropelike mass

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Septic Pelvic Thrombophlebitis

• Treatment
• IV heparin to an aPtt twice normal
• Long-term anticoagulation not required
• Continued antibiotic therapy
• Gentamicin and clindamycin
• Recent study

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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

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Questions

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

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Questions

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

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Questions

• True or False
• Atelectasis can cause fever