postnatal infections Flashcards
intra amniotic infection
previously called chorioamnionitis
amniotic fluid, placenta, fetus, fetal membranes or decidua
bugs in intra amniotic infection
polymicrbial and caused by ascending cervicovaginal organisms
may result rarely from a maternal bacteraemia (e.g. listeria monocytogenes) or as a direct result of invasive procedures (e.g. amniocentesis)
group B strep
strep agalcatiae
gram positive coccus in chains
GBS disease in pregnancy
urinary tract infection
upper genital tract infection - chorioamnionitis
post partum enodmetritis
pneumonia and meningitis in the baby
GBS increases risk of
preterm birth
premature rupture of membranes
leading cause of chorioamnionitis
GBSS infection in the baby
sepsis
pneumonia
meningitis
early onset neonatal GBS
36% fatality
meningitis survivors sometimes have moderate to severe neurological impairment
risk factors for GBS
rectovaginal colonisation of mother
50% transmission rate but only 1-2% will develop disease
prevention of GBS disease
prev ent transmission by giving antibiotics during labour as prophylaxis
screening of GBSs
take swabs for all pregnant women at 35-37 weeks
treat those who are GBS positive with antibiotics during labour to prevent GBS spread to baby
risk based approach
don’t use screening cultures - just treat those with risk factors
cons of culture based antibiotics
increased exposure to antibiotics, maternal anaphylaxis, number need to treat high, over and under treatment to transient carriage, dependant on specimens taken and types of culture used, effect on microbiome, increased medicalisation, cost effectiveness
listeria monocytogenes infection
uncommon infection
gram positive rod
multiplies at low temperature
carriage of listeria monocytogenes
asympomatic maternal carriage
or
flu like illness in mother
fetal loss common, neonatal death in 25% of pregnancy cases
treatment regimens
benxylpenecillin or amoxicillin
post partum fever
fever 2-10 days after birth
low grade fevers common 24 hours after birth that usually resolves
post partum fever differential diagnosis
surgical site infection, endometritis, retained products of conception mastitis or breast abscess urinary tract infection septic pelvic thrombophlebitis clostridium difficile drug fever
endometritis
inflammation and infection of the lining of the endometrium - the lining of the uterus
uterine or adnexal tenderness
purulent and/or offensive lochia
fever
Caesarean section
risk factor for endometiritis
particularly after labour has commenced or those with bacterial veginnosis
peri-operative prophylaxis has reduced risk
antecedent intra amniotic infection
also risk factor for endometritis
can be clinically silent
endometritis microbiology
migration of normal flora into uterus
polymicrobial
post partum infection treatment
amoxicillin or cafazolin
plus gentamicin and metronidazole
mastitis
inflammation of the breast milk stasis can become infection - red swollen, form, tender part of the breast systemic - fever and flu like symptoms may develop breast abscess
predisposing factors to mastitis
poor positioning/attachment damaged nipples - especially if colonised with staph aureus incomplete draining of the breast inadequate/inappropriate treatment f previous mastitis ankyloglossia abrupt weaning scarring causing incomplete drainage restrictive bra/clothing
