{"id":231,"date":"2020-08-13T16:42:41","date_gmt":"2020-08-13T16:42:41","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=231"},"modified":"2023-09-30T10:31:55","modified_gmt":"2023-09-30T10:31:55","slug":"28-postpartum-infection","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/28-postpartum-infection\/","title":{"rendered":"28. Postpartum Infection"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/sk9hCAjgUyQ\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 4:08<\/p>\n<input type='hidden' bg_collapse_expand='69e9dc12804e21015154774' value='69e9dc12804e21015154774'><input type='hidden' id='bg-show-more-text-69e9dc12804e21015154774' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9dc12804e21015154774' value='Hide Transcript'><button id='bg-showmore-action-69e9dc12804e21015154774' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9dc12804e21015154774' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 28<br \/>\n00:02<br \/>\npostpartum infection the rates of<br \/>\n00:05<br \/>\npostpartum complications have been<br \/>\n00:06<br \/>\nincreasing in recent decades thought to<br \/>\n00:08<br \/>\nbe mainly secondary to the increased<br \/>\n00:10<br \/>\nrates of cesarean deliveries early<br \/>\n00:12<br \/>\nrecognition and treatment of postpartum<br \/>\n00:14<br \/>\ninfections decreased maternal morbidity<br \/>\n00:15<br \/>\nand mortality the objectives of this<br \/>\n00:18<br \/>\nvideo are to list the risk factors for<br \/>\n00:19<br \/>\npostpartum infection list common<br \/>\n00:22<br \/>\npostpartum infections and lastly develop<br \/>\n00:24<br \/>\nan evaluation and management plan for<br \/>\n00:26<br \/>\nthe patient with postpartum infections<br \/>\n00:28<br \/>\nhere you are for medical students<br \/>\n00:30<br \/>\nextraordinaire the four of you receive<br \/>\n00:33<br \/>\nfour distinct pages that a postpartum<br \/>\n00:35<br \/>\npatient has had an elevated temperature<br \/>\n00:37<br \/>\nlet&#8217;s start with a basic definition of<br \/>\n00:39<br \/>\nwhat we consider to be a fever a<br \/>\n00:41<br \/>\ntemperature above 38 degrees Celsius or<br \/>\n00:43<br \/>\n100 point 4 degrees Fahrenheit is<br \/>\n00:45<br \/>\nconsidered a fever how do we approach<br \/>\n00:48<br \/>\nthe patient with a postpartum fever<br \/>\n00:50<br \/>\nwe should always start with a good<br \/>\n00:52<br \/>\nhistory ask the patient if there&#8217;s a<br \/>\n00:54<br \/>\nsource of pain or redness or drainage<br \/>\n00:57<br \/>\nfind out from the patient whether she<br \/>\n00:59<br \/>\nhad a vaginal delivery or a caesarean<br \/>\n01:01<br \/>\nsection and whether there are any<br \/>\n01:02<br \/>\ncomplications during the pregnancy or<br \/>\n01:04<br \/>\nlabor course determine whether she has<br \/>\n01:06<br \/>\nany medical issues or any other risk<br \/>\n01:08<br \/>\nfactors that would increase her risk of<br \/>\n01:10<br \/>\npoor wound healing such as smoking on<br \/>\n01:12<br \/>\nphysical examination try to identify the<br \/>\n01:14<br \/>\nsource of the infection by focusing on<br \/>\n01:16<br \/>\nthe important organ systems that could<br \/>\n01:17<br \/>\nbe infected in the postpartum time what<br \/>\n01:20<br \/>\nare the common postpartum infections<br \/>\n01:21<br \/>\nthat will be in our differential<br \/>\n01:22<br \/>\ndiagnosis urinary tract infection wound<br \/>\n01:25<br \/>\ninfection mastitis or breast abscess and<br \/>\n01:27<br \/>\nthe metritis septic pelvic<br \/>\n01:29<br \/>\nthrombophlebitis drug reaction c<br \/>\n01:31<br \/>\ndifficile associated diarrhea or<br \/>\n01:33<br \/>\ncomplications related to anesthesia we<br \/>\n01:36<br \/>\nwill concentrate on the first four items<br \/>\n01:37<br \/>\nthat are differential since these are<br \/>\n01:39<br \/>\nthe four more common ideologies for<br \/>\n01:40<br \/>\npostpartum infection women who have had<br \/>\n01:43<br \/>\na Foley catheter or a vaginal procedure<br \/>\n01:45<br \/>\nat increased risk of developing a<br \/>\n01:46<br \/>\nurinary tract infection so that&#8217;s pretty<br \/>\n01:48<br \/>\nmuch any postpartum patient bacteria of<br \/>\n01:51<br \/>\nthe normal bowel floor are the most<br \/>\n01:53<br \/>\ncommon pathogens including ecoli<br \/>\n01:55<br \/>\nKlebsiella Proteus and enterobacter in<br \/>\n01:57<br \/>\nterms of therapy don&#8217;t forget to ask her<br \/>\n02:00<br \/>\nif she is breastfeeding for this will<br \/>\n02:01<br \/>\ninfluence which antibiotic you choose<br \/>\n02:03<br \/>\nthe most common antibiotics for treating<br \/>\n02:06<br \/>\nurinary tract infection in the<br \/>\n02:07<br \/>\npostpartum time are either nitro fear in<br \/>\n02:09<br \/>\ntone or a cephalosporin it is very rare<br \/>\n02:11<br \/>\nfor a patient to have an effect<br \/>\n02:13<br \/>\nyou know the perineal laceration or<br \/>\n02:14<br \/>\nepisiotomy site despite the millions of<br \/>\n02:17<br \/>\nbacteria that are present at the site of<br \/>\n02:18<br \/>\nhealing less than 1% of women will<br \/>\n02:20<br \/>\ndevelop an infection if she is in that<br \/>\n02:24<br \/>\nunlucky 1% she will often present with<br \/>\n02:26<br \/>\npain and purulent discharge from the<br \/>\n02:28<br \/>\nperineal laceration repair site like all<br \/>\n02:30<br \/>\nwounds as they heal the pain should<br \/>\n02:32<br \/>\ndecrease pain that starts to increase<br \/>\n02:34<br \/>\nduring the recovery phase should be a<br \/>\n02:36<br \/>\nclue that something may be wrong most<br \/>\n02:38<br \/>\nwound infections are cesarean section<br \/>\n02:40<br \/>\nwound infections so this is thus our<br \/>\n02:42<br \/>\nlargest risk factor patients who&#8217;ve had<br \/>\n02:44<br \/>\na cesarean section after labour are a<br \/>\n02:46<br \/>\nparticular risk and additional risk<br \/>\n02:48<br \/>\nfactors include diabetes obesity and<br \/>\n02:50<br \/>\nsmoking the organisms responsible for<br \/>\n02:52<br \/>\nwound infections are streptococcus<br \/>\n02:54<br \/>\nstaphylococcus species and gram negative<br \/>\n02:56<br \/>\norganisms a cephalosporin is generally<br \/>\n02:59<br \/>\nthe first line of treatment and this<br \/>\n03:00<br \/>\nwill be inpatient or outpatient<br \/>\n03:02<br \/>\ndepending on the severity of the<br \/>\n03:03<br \/>\ninfection any breastfeeding patient is<br \/>\n03:06<br \/>\nat risk of developing mastitis and this<br \/>\n03:07<br \/>\ntopic is covered more fully in our<br \/>\n03:09<br \/>\nlactation video staph aureus is the most<br \/>\n03:12<br \/>\ncommon organism involved and treatment<br \/>\n03:14<br \/>\nis generally a seven to ten day course<br \/>\n03:16<br \/>\nof dicloxacillin the route of delivery<br \/>\n03:18<br \/>\nis also the single most important risk<br \/>\n03:20<br \/>\nfactor for developing endometritis<br \/>\n03:22<br \/>\nhaving a caesarean section is also the<br \/>\n03:24<br \/>\nbiggest risk factor other risk factors<br \/>\n03:26<br \/>\ninclude prolonged rupture of membranes<br \/>\n03:27<br \/>\nprolonged internal fetal monitoring<br \/>\n03:30<br \/>\nanaemia and decreased socioeconomic<br \/>\n03:32<br \/>\nstatus and a metritis tends to be a<br \/>\n03:34<br \/>\npolymicrobial infection involving two or<br \/>\n03:36<br \/>\nthree aerobic and anaerobic organisms<br \/>\n03:38<br \/>\nfor the genital tract patients are<br \/>\n03:41<br \/>\nadmitted to the hospital and placed on<br \/>\n03:42<br \/>\nbroad-spectrum IV antibiotics gentamicin<br \/>\n03:45<br \/>\nand clindamycin are usually the<br \/>\n03:46<br \/>\nfirst-line therapy this concludes the<br \/>\n03:49<br \/>\naapko video on postpartum infections<br \/>\n03:50<br \/>\nwe&#8217;ve discussed the most common<br \/>\n03:52<br \/>\ninfections we&#8217;ve discussed risk factors<br \/>\n03:53<br \/>\nand developed an evaluation and<br \/>\n03:55<br \/>\nmanagement plan for a patient with a<br \/>\n03:56<br \/>\npostpartum infection<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 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