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OB46 Obstetrics
Puerperal Complications Toronto Notes 2019
Etiology of Postpartum Pyrexia
B-5W
Breast: engorgement, mastitis
Wind: atelectasis, pneumonia
Water: UTI
Wound: episiotomy, C/S site infection Walking: DVT, thrombophlebitis Womb: endometritis
Management
• urgentmanagementessential,callanesthesia
• ABCs:initiateIVcrystalloids
• canusetocolyticdrug(seePretermLabour,OB16)ornitroglycerinIVtorelaxuterusandaid
replacement
• replaceuteruswithoutremovingplacenta
• removeplacentamanuallyandwithdrawslowly • IVoxytocininfusion(onlyafteruterusreplaced) • re-exploreuterus
• mayrequiregeneralanesthetic±laparotomy
Postpartum Pyrexia
Definition
• fever>38°Conany2ofthefirst10dpostpartum,exceptthefirstday
Etiology
• endometritis
• woundinfection(checkC/Sandepisiotomysites) • mastitis/engorgement
• UTI
• atelectasis
• pneumonia
• DVT,pelvicthombophlebitis
Investigations
• detailedhistoryandphysicalexam,relevantcultures • forendometritis:bloodandgenitalcultures
• serumlacticacidforearlydetectionofsepsis
Treatment
• dependsonetiology
■ infection: empiric antibiotics, adjust when sensitivities available
• endometritis:clindamycin+gentamycinIV
• mastitis:cloxacillinorcephalexin
• woundinfection:cephalexin,frequentsitzbathsforepisiotomysiteinfection
■ DVT: anticoagulants
• prophylaxisagainstpost-C/Sendometritis:administer2gcefazolinIV30minpriortoskinincision
ENDOMETRITIS
• definition:inflammationoftheendometriummostcommonlyduetoinfection
• clinicalfeatures:fever,chills,abdominalpain,uterinetenderness,foul-smellingvaginaldischarge,or
lochia
• treatment:dependsoninfectionseverity;oralantibioticsifwell,IVwithhospitalizationinmoderateto
severe cases
VENOUS THROMBOEMBOLISM
• seeVenousThromboembolism,OB30
Risk Factors for Endometritis
C/S, intrapartum chorioamnionitis, prolonged labour, prolonged ROM, multiple vaginal examinations
