Postpartum Infection

Postpartum Infection is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Postpartum endometritis (PPE):
    • Early PPE
      • Develops within 48 hr
      • Most often complicating C-section
      • Occurs in 1–3% of uncomplicated vaginal deliveries
      • Classic triad: Fever, lower abdominal pain with uterine tenderness, foul-smelling lochia
    • Late PPE
      • Develops 3 days–6 wk after delivery
      • Usually follows vaginal delivery
    • Risk of PPE as high as 85–95% in high-risk nonelective C-section patient
  • Complications of PPE: All are more common after C-section:
    • Pelvic thrombophlebitis
    • Pelvic abscess
    • Bacteremia
  • Risk factors for PPE:
    • C-section
    • Prolonged labor
    • Prolonged rupture of membranes
    • Increased number of vaginal exams
    • Use of internal fetal monitoring
  • Septic pelvic thrombophlebitis is a diagnosis of exclusion with 2 distinct clinical presentations, either of which may present with postpartum pulmonary embolus:
    • Acute thrombosis:
      • Most common in right ovarian vein
      • Usually occurs in 1st 48 hr as acute, progressive lower abdominal pain
    • Enigmatic fever: “Picket fence” spiking fevers and tachycardia
  • Septic abortion:
    • Uncommon in developing countries
    • Usually an ascending infection through an open cervical os
    • Associated with:
      • Nonsterile techniques, instruments
      • Retained products of conception
  • Mastitis:
    • Ranges from mild breast redness to fever, systemic illness, and abscess
    • Common (1–30% of postpartum patients)
    • Occurs within the 1st 3 mo postpartum
    • Peaks at 2–3 wk
    • Recurs in 4–8%
  • UTI/pyelonephritis:
    • Along with mastitis accounts for 80% of postpartum infections

Etiology

  • PPE:
    • Polymicrobial infection result of ascending spread from lower genital tract
    • Anaerobic (up to 80%) and aerobic (∼70%):
    • Gram-positive aerobes:
      • Group A, B streptococci
      • Enterococci
      • Gardnerella vaginalis
    • Gram-negative aerobes:
      • Escherichia coli
      • Enterobacter
    • Anaerobes:
      • Bacteroides
      • Peptostreptococcus
    • Other genital mycoplasmas common in late PPE:
      • Ureaplasma urealyticum
      • Mycoplasma hominids
      • Chlamydia trachomatis
  • Septic abortion:
    • Usually polymicrobial
    • E. coli
    • Bacteroides
    • Anaerobic gram-negative rods
    • Group B streptococci
    • Staphylococcus
    • STD:
      • Gonorrhea
      • C. trachomatis
      • Trichomonas
  • Mastitis
    • Staphylococcus aureus
    • Group A and B hemolytic streptococci
    • E. coli
    • Bacteroides

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Citation

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TY - ELEC T1 - Postpartum Infection ID - 307137 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307137/all/Postpartum_Infection ER -