{"id":2628,"date":"2020-08-13T20:25:05","date_gmt":"2020-08-13T20:25:05","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=402"},"modified":"2020-08-13T20:25:05","modified_gmt":"2020-08-13T20:25:05","slug":"puerperium","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/advanced-training\/puerperium\/","title":{"rendered":"Puerperium"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/V002a9nDIgM\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration 6:23<\/p>\n<input type='hidden' bg_collapse_expand='69e9b59e5242a8080353155' value='69e9b59e5242a8080353155'><input type='hidden' id='bg-show-more-text-69e9b59e5242a8080353155' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b59e5242a8080353155' value='Hide Transcript'><button id='bg-showmore-action-69e9b59e5242a8080353155' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#faf7f7;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b59e5242a8080353155' ><\/p>\n<p>00:01<br \/>\nEvidence-based management<br \/>\n00:02<br \/>\nof postpartum infection.<br \/>\n00:03<br \/>\n00:06<br \/>\nThis is an outline<br \/>\n00:07<br \/>\nof our presentation today.<br \/>\n00:09<br \/>\nWe&#8217;ll start off by giving<br \/>\n00:10<br \/>\na brief introduction<br \/>\n00:12<br \/>\nto postpartum infections.<br \/>\n00:13<br \/>\nIn particular, we will discuss<br \/>\n00:15<br \/>\nendomyometritis, wound<br \/>\n00:17<br \/>\ninfection, urinary tract<br \/>\n00:19<br \/>\ninfections, and mastitis,<br \/>\n00:21<br \/>\nwith the focus<br \/>\n00:22<br \/>\non their etiology,<br \/>\n00:23<br \/>\nassociated risk factors, signs<br \/>\n00:26<br \/>\nand symptoms, and management.<br \/>\n00:27<br \/>\n00:30<br \/>\nGeneral risk factors<br \/>\n00:32<br \/>\nfor postpartum infection<br \/>\n00:33<br \/>\ninclude Cesarean delivery,<br \/>\n00:36<br \/>\nprolonged rupture of membranes,<br \/>\n00:38<br \/>\nurinary catheterization,<br \/>\n00:40<br \/>\ndiabetes, group B strep<br \/>\n00:42<br \/>\ninfection, anemia, and obesity.<br \/>\n00:45<br \/>\n00:48<br \/>\nThe first postpartum infection<br \/>\n00:50<br \/>\nwe will discuss<br \/>\n00:51<br \/>\nis endomyometritis.<br \/>\n00:53<br \/>\nEndomyometritis is<br \/>\n00:54<br \/>\na polymicrobial infection<br \/>\n00:56<br \/>\nof the uterine lining<br \/>\n00:57<br \/>\nand underlying wall.<br \/>\n00:59<br \/>\nRisk factors for developing<br \/>\n01:00<br \/>\nendomyometritis<br \/>\n01:02<br \/>\ninclude lower segment Cesarean<br \/>\n01:04<br \/>\nsection, manual removal<br \/>\n01:06<br \/>\nof the placenta,<br \/>\n01:07<br \/>\nretained products of conception,<br \/>\n01:09<br \/>\nchorioamnionitis,<br \/>\n01:11<br \/>\nand premature rupture<br \/>\n01:12<br \/>\nof membranes.<br \/>\n01:14<br \/>\nPatients present with fever<br \/>\n01:16<br \/>\nand uterine tenderness,<br \/>\n01:17<br \/>\ntypically five to 10 days<br \/>\n01:18<br \/>\nfollowing delivery.<br \/>\n01:19<br \/>\n01:22<br \/>\nBecause retained products<br \/>\n01:24<br \/>\nof conception<br \/>\n01:24<br \/>\ncan be the etiology<br \/>\n01:26<br \/>\nof infection, ultrasound<br \/>\n01:27<br \/>\nis often obtained to examine<br \/>\n01:29<br \/>\nthe intrauterine contents.<br \/>\n01:31<br \/>\nFull blood count<br \/>\n01:32<br \/>\nand C-reactive protein<br \/>\n01:34<br \/>\nare also routinely done.<br \/>\n01:36<br \/>\nUsually treated<br \/>\n01:37<br \/>\nwith broad-spectrum<br \/>\n01:38<br \/>\nintravenous antibiotics,<br \/>\n01:39<br \/>\nsuch as second-generation<br \/>\n01:40<br \/>\ncephalosporins.<br \/>\n01:42<br \/>\nIf products of conception<br \/>\n01:43<br \/>\nare identified on ultrasound,<br \/>\n01:45<br \/>\ndilation and curettage<br \/>\n01:47<br \/>\nis performed.<br \/>\n01:48<br \/>\nAntibiotics are continued<br \/>\n01:50<br \/>\nuntil the patient is afebrile<br \/>\n01:51<br \/>\nfor 48 hours, uterine pain<br \/>\n01:54<br \/>\nand tenderness are absent,<br \/>\n01:56<br \/>\nand white blood cell count<br \/>\n01:57<br \/>\nis normal.<br \/>\n01:58<br \/>\nThe routine use of antibiotics<br \/>\n02:00<br \/>\nhas proven to be<br \/>\n02:01<br \/>\nbeneficial<br \/>\n02:02<br \/>\nin high-risk obstetric patients<br \/>\n02:04<br \/>\nwith postpartum endometritis&#8211;<br \/>\n02:07<br \/>\nfor example,<br \/>\n02:08<br \/>\npatients with prolonged labor<br \/>\n02:09<br \/>\nor prolonged rupture<br \/>\n02:10<br \/>\nof membranes.<br \/>\n02:11<br \/>\n02:14<br \/>\nPostpartum wound infections are<br \/>\n02:16<br \/>\nuncommon.<br \/>\n02:17<br \/>\nThey occur in 1% to 5%<br \/>\n02:19<br \/>\nof Cesarean skin incisions<br \/>\n02:21<br \/>\nand 0.1% of perineal lacerations<br \/>\n02:24<br \/>\nor episiotomy sites.<br \/>\n02:26<br \/>\nMost often,<br \/>\n02:27<br \/>\nthe etiologic organisms<br \/>\n02:29<br \/>\nassociated with wound infections<br \/>\n02:30<br \/>\nare skin flora, including<br \/>\n02:32<br \/>\nstaphylococcus or streptococcus<br \/>\n02:35<br \/>\nspecies,<br \/>\n02:36<br \/>\nand gram-negative organisms as<br \/>\n02:38<br \/>\nin endometritis.<br \/>\n02:38<br \/>\n02:42<br \/>\nSigns and symptoms of wound<br \/>\n02:43<br \/>\ninfection usually occur four<br \/>\n02:45<br \/>\nto seven days later.<br \/>\n02:47<br \/>\nThese would include fever,<br \/>\n02:48<br \/>\nparticularly<br \/>\n02:49<br \/>\nwith infected Cesarean section<br \/>\n02:51<br \/>\nincisions, erythema<br \/>\n02:53<br \/>\naround the wound site,<br \/>\n02:54<br \/>\nparticularly if it&#8217;s associated<br \/>\n02:56<br \/>\nwith tenderness, and warmth.<br \/>\n02:58<br \/>\nPurulent discharge<br \/>\n02:59<br \/>\nfrom the wound site is a telling<br \/>\n03:01<br \/>\nsign.<br \/>\n03:02<br \/>\nIf the infection does not<br \/>\n03:03<br \/>\nrespond to antibiotics<br \/>\n03:05<br \/>\nand persistent fever<br \/>\n03:06<br \/>\nor there is<br \/>\n03:07<br \/>\na fluctuant collection<br \/>\n03:08<br \/>\nwithin the wound site,<br \/>\n03:10<br \/>\nan abscess should be suspected.<br \/>\n03:11<br \/>\n03:15<br \/>\nTreatment entails proper wound<br \/>\n03:16<br \/>\ncleaning and care.<br \/>\n03:18<br \/>\nAbscesses must be incised,<br \/>\n03:20<br \/>\ndrained, and properly cleaned<br \/>\n03:22<br \/>\nand dressed as a delay may lead<br \/>\n03:24<br \/>\nto necrotizing fasciitis.<br \/>\n03:27<br \/>\nPatients should be treated<br \/>\n03:28<br \/>\nwith broad-spectrum antibiotics<br \/>\n03:30<br \/>\nwith the focus<br \/>\n03:31<br \/>\non covering skin flora.<br \/>\n03:33<br \/>\nBefore giving<br \/>\n03:33<br \/>\nbroad-spectrum antibiotics,<br \/>\n03:35<br \/>\na wound culture swab should be<br \/>\n03:37<br \/>\nobtained to determine<br \/>\n03:38<br \/>\nthe causative organisms<br \/>\n03:40<br \/>\nand the antibiotic sensitivity<br \/>\n03:41<br \/>\nprofile<br \/>\n03:42<br \/>\nso<br \/>\n03:43<br \/>\nthat definitive antimicrobial<br \/>\n03:45<br \/>\ntherapy can be implemented.<br \/>\n03:47<br \/>\nFinally,<br \/>\n03:48<br \/>\nas a preventive measure,<br \/>\n03:49<br \/>\nprophylactic antibiotics should<br \/>\n03:51<br \/>\nbe given for all Cesarean<br \/>\n03:52<br \/>\nsections.<br \/>\n03:52<br \/>\n03:56<br \/>\nUrinary tract infections often<br \/>\n03:58<br \/>\nresult<br \/>\n03:58<br \/>\nfrom urinary catheterization<br \/>\n04:00<br \/>\nduring and after labor.<br \/>\n04:02<br \/>\nCatheterizations are required<br \/>\n04:03<br \/>\nfor epidural and spinal<br \/>\n04:05<br \/>\nanesthesia<br \/>\n04:06<br \/>\nto avoid urinary retention.<br \/>\n04:08<br \/>\nUrinary tract infections can<br \/>\n04:10<br \/>\ntravel up to involve the bladder<br \/>\n04:12<br \/>\nand the kidneys, causing<br \/>\n04:14<br \/>\ncystitis and pyelonephritis<br \/>\n04:15<br \/>\n[INAUDIBLE].<br \/>\n04:17<br \/>\nSymptoms include<br \/>\n04:19<br \/>\nurinary frequency, dysuria,<br \/>\n04:21<br \/>\nflank pain, costovertebral angle<br \/>\n04:24<br \/>\ntenderness,<br \/>\n04:25<br \/>\nsuprapubic tenderness,<br \/>\n04:26<br \/>\nand fever.<br \/>\n04:27<br \/>\nDiagnosis is made by urinalysis<br \/>\n04:31<br \/>\nand urine culture.<br \/>\n04:32<br \/>\nTreatment consists<br \/>\n04:33<br \/>\nof<br \/>\n04:34<br \/>\ntrimethoprim-sulfamethoxazole,<br \/>\n04:36<br \/>\nnitrofurantoin,<br \/>\n04:38<br \/>\nfluoroquinolones.<br \/>\n04:40<br \/>\nThese drugs are safe to use<br \/>\n04:41<br \/>\nin breastfeeding mothers.<br \/>\n04:43<br \/>\nNevertheless, care should be<br \/>\n04:45<br \/>\ntaken to avoid breastfeeding<br \/>\n04:46<br \/>\nthe infant within four hours<br \/>\n04:48<br \/>\nof taking the drug to minimize<br \/>\n04:50<br \/>\nexposure.<br \/>\n04:50<br \/>\n04:53<br \/>\nMastitis is a regional infection<br \/>\n04:55<br \/>\nof the breast which is caused<br \/>\n04:57<br \/>\nby the mother&#8217;s skin flora<br \/>\n04:59<br \/>\nor baby&#8217;s oral flora.<br \/>\n05:01<br \/>\nThese bacteria can penetrate<br \/>\n05:02<br \/>\nthrough a cracked nipple<br \/>\n05:04<br \/>\nand proliferate causing symptoms<br \/>\n05:06<br \/>\nof infection.<br \/>\n05:08<br \/>\nCommonly, lactating women will<br \/>\n05:10<br \/>\nhave warm, diffusely tender,<br \/>\n05:12<br \/>\nand firm breasts,<br \/>\n05:13<br \/>\nespecially at the time of breast<br \/>\n05:15<br \/>\nengorgement and milk<br \/>\n05:16<br \/>\n[INAUDIBLE].<br \/>\n05:17<br \/>\nThese are the normal signs<br \/>\n05:19<br \/>\nand are not signs of mastitis.<br \/>\n05:21<br \/>\nThe infection typically presents<br \/>\n05:23<br \/>\nwith focal tenderness, erythema,<br \/>\n05:25<br \/>\nand differences in temperature<br \/>\n05:27<br \/>\nfrom one region of the breast<br \/>\n05:28<br \/>\nto another.<br \/>\n05:30<br \/>\nMastitis might also complicated<br \/>\n05:32<br \/>\nby formation of an abscess.<br \/>\n05:34<br \/>\nMastitis is diagnosed<br \/>\n05:36<br \/>\nby physical examination<br \/>\n05:37<br \/>\nof the breasts.<br \/>\n05:38<br \/>\nFever and elevated white cell<br \/>\n05:40<br \/>\ncount are common.<br \/>\n05:42<br \/>\nMastitis is treated<br \/>\n05:43<br \/>\nwith oral antibiotics.<br \/>\n05:45<br \/>\nIt is worth noting<br \/>\n05:46<br \/>\nthat a patient should continue<br \/>\n05:48<br \/>\nbreastfeeding as it helps<br \/>\n05:49<br \/>\nto remove bacteria<br \/>\n05:50<br \/>\nfrom the breast.<br \/>\n05:52<br \/>\nIf breastfeeding is not<br \/>\n05:53<br \/>\npossible, then the patient<br \/>\n05:55<br \/>\nshould pump breasts<br \/>\n05:56<br \/>\nin acute phase of the infection.<br \/>\n05:59<br \/>\nIf oral therapy fails,<br \/>\n06:01<br \/>\nthen IV antibiotics should be<br \/>\n06:02<br \/>\nstarted until the patient is<br \/>\n06:04<br \/>\nafebrile for 48 hours.<br \/>\n06:07<br \/>\nIf this fails, then an abscess<br \/>\n06:08<br \/>\nshould be suspected<br \/>\n06:10<br \/>\nand confirmed by imaging<br \/>\n06:11<br \/>\nstudies.<br \/>\n06:12<br \/>\nThe abscess is treated<br \/>\n06:14<br \/>\nwith incision and drainage.<br \/>\n06:15<br \/>\n06:18<br \/>\nBrought to you by Learning<br \/>\n06:20<br \/>\nIn Ten.<\/p>\n<p><\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration 6:23 &nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":160,"menu_order":15,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2628","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2628","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=2628"}],"version-history":[{"count":0,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/2628\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/160"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=2628"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}