OGCO-C4.4 Management of puerperium

Question 1

What should be reported in daily ward round?

Answer 1

Question 2

What is the lactation advices?

Answer 2

Question 3

What is the cause and Mx for postpartum urinary retention?

Answer 3

Question 4

What Hx taking and P/E should be performed for puerperal fever?

Answer 4

Puerperal fever
* History taking and the following physical examination should be performed
o Chest examination if any respiratory symptoms
o Breast examination to look for breast engorgement and to rule out breast abscesses
o Abdominal examination to look for abdominal or uterine tenderness
o Review Caesarean section/ perineal wound condition
o Examination of the calves for possible thromboembolism
* Reactionary fever may occur in the first 24 hours following a surgery
* Blood tests including complete blood count, electrolytes, blood cultures should be obtained prior to administration of antibiotics
* Serum lactate should be measured in patients with a suspicion of severe sepsis, a level of ≥4 mmol/L is indicative of tissue hypoperfusion
* Other relevant imaging studies including chest X-ray, pelvic ultrasound or CT abdomen and pelvis should be arranged if pelvic abscess is suspected
* Empirical broad-spectrum antibiotics should be considered if fever persisted, or any symptoms and signs suggestive of infection