Post Partum Pyrexia (P349-STG)

Question 1

Definition

Answer 1

Post-partum pyrexia refers to body temperature of 38°C or more on 2 or more occasions during the first 10 days of the puerperium excluding the first day.

OR

Postpartum pyrexia is any temperature rise above 38 °C maintained over 24 h or recurring between the end of the first to the end of the 10th day after childbirth

Question 2

puerperium

Instrumental delivery

Birth canal injury

Answer 2

puerperium— the period of about six weeks after childbirth during which the mother’s reproductive organs return to their original non-pregnant condition.

Instrumental delivery— An assisted birth (also known as an instrumental delivery) is when forceps or a ventouse suction cup are used to help deliver the baby. Ventouse and forceps are safe and only used when necessary for you and your baby. Assisted delivery is less common in women who’ve had a spontaneous vaginal birth before.

Birth canal injuries— Birth injury is damage that occurs as a result of physical pressure during the birthing process, usually during transit through the birth canal. Many newborns have minor injuries during birth. Infrequently, nerves are damaged or bones are broken. Most injuries resolve without treatment.

Question 3

Risk factors for Postpartum pyrexia

Answer 3

Risk Factors include:

— prolonged labour,
— prolonged premature rupture of membranes,
— retained placental tissue,
— instrumental deliveries and
— birth canal injuries.

Question 4

Causes of Postpartum pyrexia

Answer 4

Causes

— Malaria
— Uterine infection (endo-myometritis: — Endometritis is inflammation of the lining of your uterus (endometrium) caused by infection.)
—Perineal Infections (e.g. infected episiotomy)
— Breast problems (engorgement, mastitis, abscess formation)
— Urinary tract infection
— Respiratory tract infection

Question 5

Signs and Symptoms

Answer 5

Signs and symptoms are related to cause
— Fever: it’s main clinical presentation is Fever.

— Signs and symptoms of malaria may include:
Fever
Chills
General feeling of discomfort
Headache
Nausea and vomiting
Diarrhea
Abdominal pain
Muscle or joint pain
Fatigue
Rapid breathing
Rapid heart rate
Cough

— Symptoms of endometritis include:
Fever.
Pelvic pain.
Vaginal bleeding or discharge.
Constipation or pain with bowel movements.
Swelling in your abdomen.
General unwell feeling.

Question 6

Investigations for Post-Partum Pyrexia

Answer 6

Investigations
y FBC
y RDT— malaria test
y Blood film for malaria parasites
y Blood for culture and sensitivity
y Urine for culture and sensitivity
y High vaginal swab
y Fasting or Random Blood Glucose
y Pelvic scan to exclude retained products of conception or pelvic
abscess

Question 7

Treatment

Treatment objectives
y To identify and treat the underlying cause

Answer 7

Treatment
Treatment objectives
y To identify and treat the underlying cause
Non-pharmacological treatment
y Examination under anaesthesia with possible uterine curettage for retained products of conception
y Encourage frequent emptying of breasts if cause is due to engorgement
y Incision and drainage for breast and perianal abscess

Pharmacological treatment

A. Breast problems - engorgement
Evidence Rating: [B]
y Paracetamol, oral, 1 g 6-8 hourly as required
B. Breast problems - mastitis/abscess
Evidence Rating: [A]
y Flucloxacillin, oral, 500 mg 6 hourly for 5-7 days
C. Endo-myometritis and perineal infections
y Amoxicillin + Clavulanic Acid, IV, 600 mg-1.2 g 8 hourly for 72 hours And
Then
Evidence Rating: [B]
y Metronidazole, IV, 500 mg 8 hourly for 72 hours
y Amoxicillin + Clavulanic Acid, oral, 625 mg-1 g 12 hourly for 7 days And
y Metronidazole, oral, 400 mg 8 hourly for 7 days Referral Criteria
Refer all cases of severe sepsis to hospital for management.

Question 8

Flowchart: Management of Postpartum pyrexia

Answer 8

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