Infection International Infection
International Objectives definition predisposing factors pathophysiology clinical features sites of postpartum infection treatment prevention
Infection International Definition: –any patient with fever of 38.5°C hours following a vaginal or forceps delivery with uterine tenderness
Infection International Incidence and scope: - major cause of maternal death in emerging countries - less frequent with vaginal births - complications include: shock, pelvic abscesses and pelvic thrombosis
Infection International Pathophysiology - normal flora of genital tract contains potential pathogens - amniotic fluid and increase in white blood cells during labour
Infection International Clinical Features - usually 2-3 days post partum - 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
Infection International Bacteria - polymicrobial - most common: Escherichia coli, Kelbsiella, Proteus and Bacteroides fragilis - less common: Clostridium, Staphylococcus aurea and Pseudomona - exogenous source: Group A beta-hemolytic streptococci
Infection International Clinical Features - 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 urinary tract episiotomy site abdominal incision breast thrombophlebitis: legs, pelvis appendicitis other: upper respiratory infection
Infection International Management - Prevention - 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: flagyl 500 mg q8h + cefoxitin 2g q6h OR aminoglysocide (gentamycin or tobramycin) 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 Specific issues: episiotomy infection: treat with antibiotics, baths (clean water!), heat - 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 Other issues - Septic pelvic thrombophlebitis--usually anaerobic sepsis - usually patient is already on antibiotics but continues to have high spiking fevers - diagnosis of exclusion - treatment is intravenous heparin - > condition should respond to heparin
Infection International Other issues - Mastitis--penicillin G or penicillinase-resistant (methicillin or cloxacillin) for 7-10 days continue breast feeding! if breast abcess--drain
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