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