Postpartum Infection

Question 1

What is endometritis?

Answer 1

common complication of prolonged labor, prolonged rupture of membranes and multiple vaginal examinations; the polymicrobial infection is mostly anaerobic and requires broad spectrum antibiotics for treatment until the patient is afebrile for 24 hours. Adding gentamicin to already prescribed ampicillin for GBS provides coverage for gram negative.

Question 2

What are erythromycin, vancomycin, cipro and doxy good for?

Answer 2

erythro provides good coverage for upper respiratory infections; vanc provides good S. aureus coverage and penicillin resistant gram positive bacteria; cipro and doxy provide excellent gram negative coverage but shouldnt be used in nursing mothers

Question 3

what are the most common causes of acute cystitis infections?

Answer 3

gram negative bacteria; E. coli(75%), P. mirabilis(8%), K. pneumoniae(20%), S. faecalis(5%), and S. agalactiae

Question 4

What is breast engorgement?

Answer 4

exaggerated response to the lymphatic and venous congestion associated with lactation; milk “let down” generally occurs on postpartum day 2 or 3; if the baby is not feeding well the breast can become engorged which can cause low grade fever

Question 5

what is postpartum fever differential?

Answer 5

endometritis, cystitis, mastitis, breast engorgement

Question 6

Prior to establishing diagnosis of surgical site infection, evaluation requires?

Answer 6

opening the wound, checking for fascial dehiscence, drainage and assessment of the fluid

Question 7

What facilitates healing in postcesarean wound?

Answer 7

packing wound until it has healed from the base of the wound

Question 8

What bacteria cause post cesarean wound infections?

Answer 8

bacteria from skin, uterus, and vagina

Question 9

What is septic pelvic thrombophlebitis?

Answer 9

thrombosis of venous system of pelvis; diagnosis is often one of exclusion of other causes and clue can be fever resistant to broad spectrum abx, treatment requires addition of short term anticoagulation to antibiotics and resolution of fever is rapid

Question 10

What is the most common source of fever on the first postpartum day?

Answer 10

lungs, especially if pt had general anesthesia; atelectasis may be associated with postpartum fever; aspiration considered in pts who had general anesthesia

Question 11

What is the gold standard abx regimen following cesarean delivery and endometritis?

Answer 11

gentamicin and clindamycin(cover anaerobics found following cesarean)

Question 12

What are complications of an epidural?

Answer 12

spinal headache, localized back pain and meningitis