Fever During and After Childbirth

Posted by e-Medical PPT
Providing Prophylactic Antibiotics
Help prevent infection, which can result from certain procedures, including:
Cesarean section
Manual removal of placenta
Correction of uterine inversion
Repair of ruptured uterus
Postpartum hysterectomy
Prolonged rupture of membranes (Group B streptococcus)
If infection is suspected or diagnosed, therapeutic antibiotics are more appropriate
Should be given 30 minutes before procedure, to allow adequate blood levels at time of procedure
Except at cesarean, give antibiotics when cord is clamped after delivery of newborn
One dose is enough (as effective as 3 doses or 24 hours of antibiotics)
If procedure is longer than 6 hours or blood loss is 1500 mL or more, give second dose.

Providing Therapeutic Antibiotics
For general treatment of obstetrical infection or until diagnosis is made, give broad spectrum antibiotics
Treat specific infection with specific antibiotics
If response is poor after 48 hours:
Ensure adequate doses of antibiotics are being given
Re-evaluate woman for other infection or abscess
Treat based on reported microbial sensitivity
End point is when:
Woman is fever-free for 48 hours
Clinical examination shows woman is improving
Woman completes course of antibiotics (in all cases except metritis)

Fever During Pregnancy and Labor: Differential Diagnosis
Cystitis
Acute pyelonephritis
Septic abortion
Amnionitis
Pneumonia
Malaria
Typhoid
Hepatitis

Obstetric and Medical Factors Affecting Postpartum Sepsis
Intervention during labor and delivery
Dangerous infections following prolonged and obstructed labor
Thrombophlebitis, pulmonary embolism, coagulopathy and septic shock may complicate the infection
Remember that clostridium infections may be difficult to detect and occur where contamination with earth or cow dung is possible

Health Service Factors Affecting Postpartum Sepsis
Majority of deaths occur between first and second week of puerperium and are linked to medical and midwifery/nursing staff factors:
 Inadequate:
monitoring of temperature
bacteriological investigations
treatment with antibiotics or operative intervention
 Lack of:
asepsis and antisepsis
blood for transfusion
appropriate drugs

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