Puerperal sepsis

Question 1

Puerperal pyrexia - def

Answer 1

Any febrile condition in a woman where a temp of >38degC or more is maintained or recurs within 14d of birth

Question 2

Puerperal pyrexia - causes

Answer 2

1. Uterine infection (endometritis)
2. Perineal wound infection
3. Breast causes (mastitis, breast abscess)
4. UTI
5. Thrombophlebitis

Question 3

Puerperal pyrexia - RF

Answer 3

1. Prolonged ROM
2. Prolonged labour
3. Instrumentation
4. CS
5. Trauma - episiotomy, vaginal tears

Question 4

Endometritis - RF

Answer 4

1. PROM
2. Prolonged labour
3. CS
4. Intrapartum chorioamnionitis
5. Internal fetal monitoring (e.g. use of scalp electrodes)

Question 5

Endometritis - sx/dx (clinical)

Answer 5

1. Postpartum fever (in proportion to extent of infection)
2. Midline lower abdominal pain
3. Tachycardia (parallels extent of infection)
4. Uterine tenderness
5. Uterine involution

**Dx = clinical

Question 6

Endometritis - mx (3)

Answer 6

1. Broad-spectrum antibiotics - clindamycin + gentamicin
2. Analgesia - NSAIDs
3. Refer to ID if women fail to respond to abx

Question 7

Puerperal pyrexia - ix

Answer 7

Identify source of infection, causative organism and abx sensitivity

1. FBE
2. Blood cultures
3. MSU
4. Swabs from cervix + lochia (vaginal discharge after birth) for bacterial culture
5. Wound swabs