Complications of the Post-partum period

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created 10 years ago by stefan_mcfarland
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Lecture 18, Med 2, Spring 2013, UFPA 2014
Grade levels:
Graduate school, Professional
Subjects:
ob/gyn
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1

Postpartum hemorrhage principal causes

Uterine atony (loss of tone)- Drugs, chorioamnionitis, uterine overdistention (multiple gestation, polyhydramnios), uterine malformation
Retained placenta - Accreta (superficial adherence), Increta (more than halfway through), Percreta (all way through - emergent hysterectomy required)
Lacerations - Cervical (most likely with precipitous labor), Vaginal (most likely with instrumental vaginal delivery)
Coagulopathy from severe pre-eclampsia, abruptio placentae, sepsis, or amniotic fluid embolism

2

Puerperal (after childbirth) infection classifications

Endometritis
Wound infection
UTI

3

Endometritis

Hx - Labor, ruptured membranes, multiple vaginal examinations, Pre-existing vaginal infection (Group B strep or BV), cesarean delivery
Sx - fever, tachycardia, pelvic pain and tenderness, no other localizing sign of infection
Dx - Clinical exam, culture
Tx - ABx - Clindamycin plus gentamycin; OR metronidazole plus PCN or ampicillin plus gentamicin; OR broad spectrum cephalosporin or PCN (cefotetan plus timentin)

4

Wound infection

Hx - Obesity, pre-existing infection (chorioamnionitis, emergency procedure, diabetes, immunodeficiency disorder
Sx - Incisional abscess, cellulitis
Dx - Clinical, culture
Tx - surgical drainage, modify ABx to target staph and strep (Nafcillin, Vancomycin)

5

UTI

Hx - Prior infection, prolonged bladder catheterization, sickle cell disease, immunodeficiency disorder
Sx - Cystitis: frequency, dysuria, hesitancy, hematuria, suprapubiic pain, low grade fever; Pyelonephritis: higher fever, chills, flank pain and tenderness
Dx - Urinalysis: pH, leukocyte esterase, nitrite test; urine culture
Tx - ABx: Oral Bactrim/Septra OR Nitrofurantoin OR Augmentin; IV: Bactrim/Septra OR Ceftriaxone OR Gentamicin OR Aztreonam

6

Thromboembolism (DVT or PE)

Prevalence 1%
Hx - Cesarean, obesity, prolonged bedrest prior to delivery, hereditary thrombophilia, sickle cell
Sx - Erythema, swelling, palpable cord; dyspnea, tachypnea, chest pain, anxiety, cardiovascular collapse
Dx - DVT: doppler flow, venography; PE: Spiral CT
Tx - Thrombolytics, anticoagulation therapy

7

What are the most common pathogens for endometritis?

Bacteroids - anaerobic gram neg rods - Clindamycin
Coliforms - aerobic gram neg rods - Gentamycin
Streptococci - anaerobic or aerobic gram pos - Clindamycin