28. Postpartum Infection

Duration = 4:08

00:00
APGO educational topic number 28
00:02
postpartum infection the rates of
00:05
postpartum complications have been
00:06
increasing in recent decades thought to
00:08
be mainly secondary to the increased
00:10
rates of cesarean deliveries early
00:12
recognition and treatment of postpartum
00:14
infections decreased maternal morbidity
00:15
and mortality the objectives of this
00:18
video are to list the risk factors for
00:19
postpartum infection list common
00:22
postpartum infections and lastly develop
00:24
an evaluation and management plan for
00:26
the patient with postpartum infections
00:28
here you are for medical students
00:30
extraordinaire the four of you receive
00:33
four distinct pages that a postpartum
00:35
patient has had an elevated temperature
00:37
let’s start with a basic definition of
00:39
what we consider to be a fever a
00:41
temperature above 38 degrees Celsius or
00:43
100 point 4 degrees Fahrenheit is
00:45
considered a fever how do we approach
00:48
the patient with a postpartum fever
00:50
we should always start with a good
00:52
history ask the patient if there’s a
00:54
source of pain or redness or drainage
00:57
find out from the patient whether she
00:59
had a vaginal delivery or a caesarean
01:01
section and whether there are any
01:02
complications during the pregnancy or
01:04
labor course determine whether she has
01:06
any medical issues or any other risk
01:08
factors that would increase her risk of
01:10
poor wound healing such as smoking on
01:12
physical examination try to identify the
01:14
source of the infection by focusing on
01:16
the important organ systems that could
01:17
be infected in the postpartum time what
01:20
are the common postpartum infections
01:21
that will be in our differential
01:22
diagnosis urinary tract infection wound
01:25
infection mastitis or breast abscess and
01:27
the metritis septic pelvic
01:29
thrombophlebitis drug reaction c
01:31
difficile associated diarrhea or
01:33
complications related to anesthesia we
01:36
will concentrate on the first four items
01:37
that are differential since these are
01:39
the four more common ideologies for
01:40
postpartum infection women who have had
01:43
a Foley catheter or a vaginal procedure
01:45
at increased risk of developing a
01:46
urinary tract infection so that’s pretty
01:48
much any postpartum patient bacteria of
01:51
the normal bowel floor are the most
01:53
common pathogens including ecoli
01:55
Klebsiella Proteus and enterobacter in
01:57
terms of therapy don’t forget to ask her
02:00
if she is breastfeeding for this will
02:01
influence which antibiotic you choose
02:03
the most common antibiotics for treating
02:06
urinary tract infection in the
02:07
postpartum time are either nitro fear in
02:09
tone or a cephalosporin it is very rare
02:11
for a patient to have an effect
02:13
you know the perineal laceration or
02:14
episiotomy site despite the millions of
02:17
bacteria that are present at the site of
02:18
healing less than 1% of women will
02:20
develop an infection if she is in that
02:24
unlucky 1% she will often present with
02:26
pain and purulent discharge from the
02:28
perineal laceration repair site like all
02:30
wounds as they heal the pain should
02:32
decrease pain that starts to increase
02:34
during the recovery phase should be a
02:36
clue that something may be wrong most
02:38
wound infections are cesarean section
02:40
wound infections so this is thus our
02:42
largest risk factor patients who’ve had
02:44
a cesarean section after labour are a
02:46
particular risk and additional risk
02:48
factors include diabetes obesity and
02:50
smoking the organisms responsible for
02:52
wound infections are streptococcus
02:54
staphylococcus species and gram negative
02:56
organisms a cephalosporin is generally
02:59
the first line of treatment and this
03:00
will be inpatient or outpatient
03:02
depending on the severity of the
03:03
infection any breastfeeding patient is
03:06
at risk of developing mastitis and this
03:07
topic is covered more fully in our
03:09
lactation video staph aureus is the most
03:12
common organism involved and treatment
03:14
is generally a seven to ten day course
03:16
of dicloxacillin the route of delivery
03:18
is also the single most important risk
03:20
factor for developing endometritis
03:22
having a caesarean section is also the
03:24
biggest risk factor other risk factors
03:26
include prolonged rupture of membranes
03:27
prolonged internal fetal monitoring
03:30
anaemia and decreased socioeconomic
03:32
status and a metritis tends to be a
03:34
polymicrobial infection involving two or
03:36
three aerobic and anaerobic organisms
03:38
for the genital tract patients are
03:41
admitted to the hospital and placed on
03:42
broad-spectrum IV antibiotics gentamicin
03:45
and clindamycin are usually the
03:46
first-line therapy this concludes the
03:49
aapko video on postpartum infections
03:50
we’ve discussed the most common
03:52
infections we’ve discussed risk factors
03:53
and developed an evaluation and
03:55
management plan for a patient with a
03:56
postpartum infection


Introductory Women's HealthCare