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International

Infectio
n

Infection

International

Infectio
n

Objectives

definition
predisposing factors
pathophysiology
clinical features
sites of postpartum infection
treatment
prevention

International

Infectio
n

Definition:
any patient with fever of 38.5C 48-72 hours
following a vaginal or forceps delivery with
uterine tenderness

International

Infectio
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Incidence and scope:


- major cause of maternal death in emerging
countries
- less frequent with vaginal births
- complications include: shock, pelvic abscesses
and pelvic thrombosis

International

Infectio
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Pathophysiology
- normal flora of genital tract contains potential
pathogens
- amniotic fluid and increase in white blood
cells during labour

International

Infectio
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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

International

Infectio
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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

International

Infectio
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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

International

Infectio
n

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

International

Infectio
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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

International

Infectio
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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)

International

Infectio
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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) 60-100
mg q8h +clindamycin 900 mg q8h

International

Infectio
n

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

International

Infectio
n

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)

International

Infectio
n

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

International

Infectio
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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

International

Infectio
n

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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