Intrapartu or postnatal maternal temperature

Question 1

Temperature greater or equal to 38 while in labor

Answer 1

Suspected chorioamnionitis in labour requires investigation and treatment
Broad spectrum antibiotic therapy that includes an agent active against GBS should replace GBS specific antibiotic prophylaxis
Notify paediatric/neonatal/medical staff if there is maternal pyrexia (intrapartum or within 24 hours of birth) as it may have implications for neonatal management
Advise women to seek advice from health care professionals if maternal temperature is greater than or equal to 38oC within 24 hours of birth (especially if discharged within 24 hours of birth)

Question 2

Causes of postpartum fever

Answer 2

B-5W
Breast: engorgement, mastitis
Wind: atelectasis, pneumonia
Water: UTI
Wound: episiotomy, C/S site infection
Walking: DVT, Thrombophlebitis
Womb: endometritis

Question 3

Ix for postpartum fever

Answer 3

Hx and Ex
Relevant cultures
for endometritis - blood and genital cultures

Question 4

Tx of postpartum fever

Answer 4

Depends on cause

• infection: empiric ABX
  
  • endometritis: clindamycin and gentamicin IV
  • mastitis: cloxacillin or cephalexin
  • Wound infection: cephalexin
• DVT: anticoagulant

Question 5

Clinical features of Endometritis

Answer 5

fever
chills
abdominal pain
uterine tenderness
Foul-smelling discharge or lochia