Wound infection/pyrexia/septic shock

Question 1

What is postpartum pyrexia?

Answer 1

Maternal fever >38C within first 14d of delivery or miscarriage

Question 2

What causes postpartum pyrexia?

Answer 2

Most commonly infection (genital tract sepsis - 90% - most common cause of maternal mortality)
Superficial perineal infection may occur from day 2+
Urinary infection accounts for 10%, but also consider chest infection, mastitis, endometritis, IV site infection and DVT (causes low-grade pyrexia)

Question 3

When is postpartum pyrexia classically seen?

Answer 3

After CS (prophylactic abx considerably reduce it)

Question 4

What microbes cause sepsis in puerperium?

Answer 4

Group A strep
Staph
E. coli

Question 5

What should be performed on examination of a woman with post-partum pyrexia?

Answer 5

Full exam of chest, breasts, bimanual (tender enlarged uterus), lochia (offensive), legs
Culture MSU, HVS, blood, sputum

Question 6

How is postpartum pyrexia managed?

Answer 6

Sepsis 6

Careful examination of all potential sites of infection + relevant cultures

Question 7

How is endometritis managed?

Answer 7

Examine - lower abdo pain, offensive lochia, tender uterus on bimanual
Abx (cefalexin 500mg/8hrs + metronidazole 400mg/8hrs)

Question 8

What kind of drugs are and what SE are associated with

a) Cefalexin
b) metronidazole
c) flucloxacillin

Answer 8

a) First generation cephalosporin; SE = none
b) Nitroimidazole (anti-anaerobes) derivative; SE = very rare, may give breast milk bitter taste in high dose
c) Penicillin (penicillinase resistant); SE = GI disturbance

Question 9

How is breast infection managed?

Answer 9

Flucoxacillin 500mg/6hrs PO early for greater than 10d to prevent abscess formation
Continue feeding/expressing to avoid stagnation of milk

Question 10

How should women be treated even if cause of infection unknown?

Answer 10

cefalexin 500mg/8hrs + Metronidazole 400mg/8hrs