Obstetrics Book

Fetal Disorders

Perinatal Disorders

Prevention

http://www.fpnotebook.com/

Postpartum EndometritisAka: Postpartum Endomyometritis

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  1. See Also
    1. Endometritis
  2. Definition
    1. Postpartum uterine infection
  3. Causes
    1. Group B Streptococcus
      1. Most common organism in the first 24 hours postpartum
    2. Mixed anaerobic and aerobic bacteria
      1. Most common organisms at 3-7 days postpartum
    3. Chlamydia
      1. Most common organism starting 2-3 weeks postpartum
  4. Signs
    1. Maternal fever
      1. Temperature > 38.0 C (100.4 F)
        1. Two separate recorded values
        2. Occurs >24 hours Postpartum
      2. Temperature > 38.7 C (101.5 F)
    2. General physical examination
      1. See Differential Diagnosis
    3. Pelvic examination
      1. Vaginal hematoma
      2. Lochia blockage
  5. Differential Diagnosis: Seven W's of maternal fever
    1. Womb
      1. Endometritis
    2. Wind
      1. Atelectasis
      2. Pneumonia
    3. Water
      1. Urinary Tract Infection
    4. Walk
      1. Deep Vein Thrombosis
      2. Pulmonary Embolism
    5. Wound
      1. Wound infection
      2. Episiotomy infection
    6. Weaning
      1. Breast engorgement
      2. Mastitis
      3. Breast abscess
    7. Wonder
      1. Drug Fever ("wonder drugs")
  6. Labs
    1. Complete Blood Count
    2. Urinalysis
    3. Urine Culture
    4. Blood Culture
  7. Radiology
    1. Chest XRay
    2. Pelvic ultrasound when indicated
  8. Management
    1. See Endometritis Antibiotic Management
      1. Continue antibiotics until 1-2 days after afebrile
    2. Persistent fever >48 to 72 hours despite antibiotics
      1. Evaluate for pelvic abscess
      2. Evaluate for septic pelvic thrombophlebitis
      3. Consider Drug Fever

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