OGCO-C4.3 Postpartum endometritis

Question 1

What are features suggestive of postpartum endometritis?

Answer 1

PE: lower abd tenderness. On bimanual examination cervical, uterine and adnexal tenderness can be elicited.
Lochia may be excessive or foul smelling but can be normal (in the setting of group A B hemolytic streptococci infection)
Pyrexia (>38C) may be present

Sepsis established in hte presence of a suspected or known infection, accompanied by 2 or more the following qSOFA variables: RR>22/min, altered mentation, systolic BP <100

Question 2

Ix for suspected postpartum endometritis?

Answer 2

Microbiological investigations (e.g. high vaginal swab, endocervical swabs, mid-stream urine for microscopy and culture and blood culture), and complete blood count should be performed prior to the commencement of antibiotics.

Question 3

Mx of postpartum endometritis?

Answer 3

Advise from department of microbiology based on local prevalence
* IV amoxicillin clavulanate 1.2g q8h (oral if mild case) as 1st line empirical treatment
* Swap to IV meropenem (1000mg q8h) and IV amikacin (750mg STAT dose x1) if persistent or worsening clinical condition in 48 hours, clinically severe condition or sepsis

Patients with penicillin allergy
Empirical oral levofloxacin (500mg daily), oral metroniazole (400mg TDS) and single dose IV amikain (750mg STAT dose x1)
Levofloxacin not contraindicated in breastfeeding mothers.
For premature infant/sick baby, nursing mother can consider to express and discard breastmilk 2 hours (peak drug level) after a dose to decrease the exposure of the infant to levofloxacin in breastmilk.

Patients given amikacin must do RFT and have dosage adjusted if RFT worsens.